JOURNAL OF 108 - CUNICAL MEDICINE AND PHARMACY V o l 1 0 - N ° 3 / 2 0 1 ^ ,
Chat liro^g cuoc s6ng va cac ySu t6 co lien quan fr bent, nhan suy than man giai doan cu6i, loc mau chu ky & Ben!
vien Trung u-ong Quan doi 108
Quality of life and related factors in chronic kidney disease patien^
requiring hemodialysis at 108 Military Central Hospital
Tr4n Phmnig Thao, Tran H^ng Nghi Benh vien Trung trang Qudn doi 1($
Tom tat
fi/fuc f/eu:Danh gia chat liTdng cuoc song va tim hieu mot so yeu to co lien quan v6i chat lu'flng song 6 benh nhan suy than man giai doan cuoi, loc mau chu ky cl Benh vien T U Q D 108. Doi ti/ang vd phuong phdp:Tien ciJu, cat ngang, mo t^, sCf dung bo cau hoi SF-36 danh gia chat lUOng cuoc song ve the chat va tinh than, tien hanh tren 79 benh nhan STMLMCK tai Khoa Noi Than - Khdp va Khoa Ipc mau, Benh vien TLTQD 108 tCr thang 12/2013 den thang 6/2014. Ket gua: 1. Benh nhan STIVIGOC c6 diem so chat laong song d miJc trung binh kem (siJc kh6e the chat la 34,55 ± 9,46, siJc kh6e tinh than la 35,18 ±13,37, siJc kh6e chung 34,75 ± 0,63). 2. Cac yeu td lien quan tdi chat iaang song la: 56 lan Ipc mau trong 1 tuan (r - - 0,241, p<0,05), tucfng quan nghich vdi thdi gian Ipc mau (p<0,05, r = -0,299} (p<0,01). Khong thay moi lien quan giCTa diem chat lapng song va nong dp ure, creatinin, uric, Hb, albumin mau (p>0,05). Ket luan: Chat lapng cuoc song 6 cac benh nhan STMLMCK d miJc trung binh kem va chi so SF-36 co taong quan nghich vdi thdi gian loc mau, sd lan Ipc mau trong 1 tuan.
TCr khoa: Chat liiong cudc sdng (CLCS), SF-36, suy than man giai doan cuoi (STMGDC), suy than man Ipc mau chu ky (STMLMCK), benh nhan.
Summary
Objective: To assess the quality of life (QOL) and its some related factors in patients vwith ESRD requiring hemodialysis 108 Military Central Hospital. Subject and method. Descnptive, cross-sectional, prospective study, used SF-36 questionnaire to determine QOL about physical and mental health, conducted in 79 patients with ESRD requiring dialysis in the Department of Nephrology and Rheumatology and Department of Hemodialysis in 108 Military Central Hospital from December 2013 to June 2014. Result: 1. The patients had the QOL in low/ - median level {physic health'score: 34.55 ± 9.46;
mental score: 35.18 ± 13.37; general health score: 34.75 ±10.63). 2. Some related factor to QOL were the dialysis times per week and the dialysis duration which inversely correlated (p<0.05). Conclusion: QOL in patient with ESRD requiring hemodialysis was in low-median level and had inverse relation with the dialysis times and duration.
Keywords: Quality of life (QOL), SF-36, ESRD, hemodialysis, patients (pts).
Phan bi?n khoa ht}c: PGS.TS. NGUYEN MAI HONG 40
TAP CHl Y DUO'C L A M SANG 108 T§p 10-So 3/2015
1 , Oat van d e
TJ le mac benh va X^ le tCf v o n g cua suy t h a n man tang nhanh t r o n g nhCfng nam vtfa qua va ty le ph^i Ipc mau tal Viet Nam cung tang rat n h a n h . Benh nhan suy than man chju rat nhieu trieu chu'ng nha: Met m o i , suy nhUdc, roi loan giac ngu, hoa mat, dau, ngiJa da... Cac trieu chCrng tren xuat hien d cac giai doan khac nhau cua suy than va ngay cang nang khi benh tien trien ve giai doan cuoi, Ipc mau chu ky. Cac trieu chu'ng do lam anh hadng ldn den chat lapng cuoc song the chat va t i n h than cCia benh nhan suy than man.
d B e n h vienTLfOD 108, so lapng benh nhan suy than man giai doan cudi, loc mau chu ky (STMLMCK) tang nhanh nhCfng nam vC^a qua. Da co nhieu nghien cu'u ve lam sang, can lam sang va dieu t n tren cac benh nhan nay. Tuy nhien, chaa co nghien cu'u nao ve chat lapng song (CL5) cua benh nhan STMLMCK tai Benh vien. Vl vay, chung tdi nghien cu:u de tai nay nham 2 muc tieu sou: 1. Danh gid chat li/Ong cuoc song va cdc yeu to co lien quan d benh nhdn suy than man giai doan cuoi, loc mdu chu ky dBenh vien TUQB 108. 2. Tim hieu mot so yeu to co lien quan vdi chat luang song d benh nhan suy than man glal doan cuoi, loc mdu chu ky dBenh vien TUQD 108.
2. Doi tUtfng va phUt^ng p h a p 2.1. Doi fitcfng nghien cuiu
Nhom nghien cCtu: Tien hanh nghien cdu d 79 benh nhan suy than man giai doan cudi dang dapc dieu tri Ipc mau chu ky d Khoa Loc mau nhan tao va Khoa npi Than - Khdp, Benh vien TLTQD 108 tCf thang 12/2013 den thang 6/2014.
Tieu chuan li/a chon:
- Benh nhan suy t h a n man t i n h giai doan cuoi Ipc mau chu kl do nhieu nguyen nhan khac nhau n h a viem cau t h a n man, viem than - be than man, tang huyet ap, dai thao d a d n g , lupus ban do he t h d n g dang dUdc dieu trj tai Khoa Than loc mau va Khoa Npi Than - Khdp, Benh vien T U Q D 108.
- Cac benh nhan khdng cd rdi loan tam than.
- Cac b e n h nhan deu daoc ap d u n g theo m o t phac do dieu trj thieu mau, dieu tri t a n g huyet ap.
Tieu chuan logi trCl:
- Benh nhan khdng d d n g y t h a m gia nghien cdu.
- B e n h nhan bj ung t h a caeca quan...
- Benh nhan suy than man t i n h loc mau chu kl kem theo roi loan tam than.
- Benh nhan tai t h d i diem nghien cu'u nghi n g d mac benh ngoai khoa, hoac viem nhiem nang n h a viem phoi, viem da day...
2.2. Phuang phap nghien cCtu
2.2.1. Thiet ke nghien CU'U-Ngh\en cdu cat ngang, m d ta, so sanh giiJa n h d m BN NC vdi n h d m chCrng va cac gia tri tham chieu,
- Tinh cd mau theo cdng thdc sau;
Trong do: Z = 1,96, do dp tin cay la 95%.
SD = 20, dp lech chuan cua gia tri SF36 d cac nghien cdu trade.
0 = 5, sal so tuyet doi.
Theo each tinh, tdi thieu nghien cdu phai cd 61 benh nhan.Trong nghien cdu s d d u n g 79 benh nhan.
2.2.2. Cdc budc tien hanh
Kham lam sang benh nhan theo mau benh an hang ngay, do huyet ap. Thu thap t h o n g t i n : Tudi, chieu cao, can nang, huyet ap, cd d u n g thuoc tao h o n g cau, tiem sat t m h mach khdng, t h d i gian Ipc mau, sd lan Ipc t r o n g 1 tuan.
Lam cac xet nghiem can tam sang t h a d n g quy.
Cac t h a m so nghien cdu t h a m khao: Ure, creatinin, uric, hemoglobin, K-F, albumin.
Phat phieu dieu tra danh gia chat luang cuoc sdng (ban djch tieng Viet cua bang cau hdi danh gia CLCS SF36) va h a d n g dan benh nhan each dien phieu da dape danh may s^n: Phdng van benh nhan, t h u thap cac mau cau tra Idi; ma hda diem trci Idi cua t d n g cau hdi; tmh diem theo t d n g linh vdc sdc khde g d m 8 ITnh vac sdc khoe; danh gia si^c khde ve the chat, t i n h than va sdc khde chung. Cach danh gia mdc dp quy d m h n h d sau:
- T d 0 - 2 5 : Chat lapng cudc song kem.
- Td 26-50: Chat Idpng cudc song trung binh kem.
-Td51-75:Chatlapngcupcs6ng trung binh kha.
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JOURNAL OF 108 - CUNICAL MEDICINE AND PHARMACY
Vol10-N°3/20,1j
- TO 76-100; Chat Wong cuoc song kha, tot.
- Tat ca cac chi so lam sang va can lam sang deu t h u thap vao buoi sang sdm truflc khi loc mau.
2.3. Xdly so lieu
Cac so lieu (Judc x i l ly bang p h u o n g phap t h o n g ke y hoc theo chuong trinh SPSS 17.0; sU khac biet CO y nghia t h o n g ke vOi p<0,05.
3. Ket qua
3.1. Bgc diem chung nhom benh nhan Bang 1 . Dac tfiem chung n h o m benh nhan
t h a n va silc k h i e c h u n g d e u i m i l e t r u n g b l ( j |
kem (26-50 fliem). j 3.3. Mot so yeu t6 CO lien quan tell chat /iToj
song d benh nhan STMLMCK
Oac diem Nhom nghien cilu (n = 791 Tuoi (nam) 61,1 ±12,9 Nhom tuoi
<20 20-39 40-59
> 6 0 GiOi nam Gi6i nCt BMI (kg/m')
BSA (m')
3 37 39 58 21 20,52 ± 2,45
1,54 ±0,16
Ty le %
0 3,8 46,8 49,4 73,4 26,6
•
Nfidn x e t : T U O I trung binh n h o m nghien cilu kha cao la 61,1 t u o i , t r o n g do chu yeu la t u o i tren 40, da phan la nam gidi (73,4%).
3.2. Chat lugng song benh nhdn suy than mgn giai doan cuoi, loc mdu chu ky
BJng 2. Bang fliem chat lUdng song SF-36 d benh nhan STMLMCK
Cac chi tieu
sac khoe the chat (5KTC) Silc khoe tinh t h i n (SKIT) Sdc khde chung (SKC)
Nhom nghien cilu n = 79 34,55 ± 9,46 35,18±13,37 34,75 ±10,63 Nhdn xet: Chat l u o n g song d n h d m nghien cilu t u o n g d d i t h a p . Silc khde t h e chat, silc khde t i n h
Nhdn xit: Chat l u o n g song cd tUong qua nghich vdi thOi gian loc mau t r o n g 1 t u a n va t6i t h d i gian da Ipc m a u (p<0,0S), tUdng quan chUa cl nghia t h o n g ke v d i ; T u o i , gidi, HA, ure, creatinin, ut Hb, A l b u m i n m a u .
TAP CHl Y DU'Q'C L A M S A N G 108 T§p 10-So 3/2015
4. Ban luan
4.1. Chat luang song d benh nhan suy than t mgn giai doan cuoi, loc mdu chu ky
I^ghien cdu nay dapc t h d c hien de nhan xet i chat laang sdng cua benh nhan suy than man giai doan cudi (STIVIGDC), loc mau chu ky (STMLMCK) va m o t so yeu t d lien quan va anh h a d n g den chat lapng sdng tai Benh vien TL/QD 108. Cac ket qua cua nghien cdu nay cd the ddpc sd d u n g de cham sdc va I dieu tri CO hieu qua hon khi chu y den cac trieu chdng va yeu t d anh hddng nham nang cao chat Iddng sdng cho benh nhan.
Nhdng nam gan day, ty le benh nhan STMLMCK - tang nhanh d Viet Nam ndi chung va d Benh vien TL/QD 108 ndi rieng. Dieu t n not khoa ket hop Ipc mau khdng chi nham duy tri cuoc song ma cdn muc .. dich nang cao chat Idpng sdng cho benh nhan
Theo phan loai cua tac gia Silveira CB va cs dda _ vao chi sd SF-36 thi n h d m nghien cdu cua chung tdi t d d n g ddi thap. Sdc khoe the chat, sdc khoe tmh
• than va sdc khoe chung deu d mdc t r u n g binh kem
^ v d i chi so sdc khde chung la 34,75 ±10,63 (26-50 / diem). Ket qua nay tdOng t d Maristela Bohlke va cs _ nghien cdu tren 91 benh nhan than nhan tao (TNT) cho diem chat Idpng sdng chung d mdc t r u n g binh
>• thap: 44,5 ± 0,3 [4]. Ket qua nay cua chung tdi thap _- han ket qua cua Hoang Bui Bao va cs (49,5 ±12,7),
Nguyen Dung (50,30 ±10,67) [1], [2]. Theo chung toi, ' viec loc mau phai t i e m chpc gay dau va viec lay mau
•—thadng xuyen de kiem tra da gay giam chat lUPng '• sdng d n h d m BN nay. Nhdm nghien cdu cua chung ' " t o i lai cd tuoi cao han rd ret {61,1 ±12,9)so v6i n h d m
^NC cua Nguyen Dung (45,74 ±16,01) nen sdc khde _ - t 6 n g quat cung bj suy giam han [2]. Nhdm nghien f:cdu cua chung tdi lai co nhieu BN phai nam npi tru
• ^ t a i Benh vien, khdng &\Jgc song cung gia dinh, thieu
^ s d cham sdc, chia se, anh h a d n g den ca the chat va j ' t i n h than n h a cac nhdm nghien cdu tren nen chat - - ' l a p n g sdng cung bi suy giam.
0
4.2. Mot so yeu to co Hen quan tdi chat li/ang ..songdbenhnhan STMLMCK
# Nhln chung chat laang sdng cua n h d m nghien cdu d mdc t r u n g binh thap ca ve sdc khoe t i n h than.
the chat va sdc khde chung. Cac ITnh viic sdc khoe chinh la: Cam nhan sdc sdng va t i n h trang t i n h t h a n t d n g quat, cam nhan dau d d n , hoat d d n g chdc nang va hbat d d n g x a hdi.
Cd nhieu yeu to duac xet den de xem mdi hen quan anh hddng den chat IdOng song. Nhdng t r o n g n h d m nghien cdu nay, chung tdi chi thay moi lien quan cd y nghfa t h d n g ke cua chat Iddng sdng vdi t h d i gian loc mau va sd lan loc mau t r o n g 1 tuan ma lien quan chda rd ret vdi cac yeu to khac n h d : Tuoi, gidi, ure, creatinin, uric, Hb, A l b u m i n mau (p>0,05).
Ket qua nay co sa khac biet vdi m d t sd tac gia trddc day khi thay CLS cd lien quan vdi t u d i , gidi, HA, Hb, ure, creatinin, Albumin mau [1], [2], [3], [4], [5], [6].Sa khac biet nay do ddi t d p n g nghien cdu cua chung toi da phan la dapc dieu tn ndi tru quanh nam nen sa khdng che HA kha t d t vdi con so HA t r u n g binh deu dddi 130/90 m m H g , sa kiem soat cac yeu t d khac n h u ure, creatinin, uric, Hb, A l b u m i n cung dat gan n h a muc tieu dieu trj do co sd theo ddi sat sac, dieu chinh kip t h d i hang ngay nen cac yeu t d nay it anh hadng den chat luang cudc sdng cua n h o m benh nhan dieu tri loc mau chu ky tal Benh vien TL/QD 108.
Hai yeu t d anh hUdng chinh den chat Idang song cua n h d m nghien cdu cua chung toi ia t h d i gian Ipc mau va sd lan Ipc mau t r o n g 1 tuan so vdi sd lan ipc mau nhieu thi su dau ddn do tiem choc kim t r o n g khi loc mau, khi lay mau xet nghiem nhieu lam anh hudng den tinh than va chiu d a n g the chat cua benh nhan, do do anh hddng den chat laang sdng, Benh nhan cang Ipc mau lau cang cd nhieu bien chdng cua suy than hay do loc mau nha: Suy t i m , cadng tuyen can giap tha phat, ton thdOng co x a a n g khdp, than kinh, da do loc mau keo dai, Idang nddc tieu giam dan den vd nieu lam an u d n g rat han che,...chinh vl vay nen chat lapng sdng suy giam.
Nhdm nghien cdu cua chung tdi cd thdi gian loc mau kha dai, t r u n g binh tren 6 nam, do da phan daac cham soc ndi tru t r o n g vien hoac cd benh an ngoai tru theo ddi dieu chinh t h a d n g xuyen, cdn cua Nguyen Dung va Hoang Bui Bao chu yeu dadi 3 nam nen cd sa khac biet nay [1], [2].
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5. Ket luan
Nghien cilu chat luong sdng dUa tren chi so SF-36 d 79 benh nhan suy than man giai doan cudi, loc mau chu ky tai Benh vien TMO 108 trong thdi gian tC( thang 12/2013 den thang 6/2014, chung tdi nhan thay:
1. Chat lUdng cudc sdng d cac benh nhan STMLMCK d mile t r u n g binh kem (chi sd SF-36 la 34,75 ±10,63).
2. Chat lupng sdng cd t u o n g quan nghich vdi t h d i gian loc mau, so lan Ipc mau trong 1 tuan, lien quan chua cd y nghia t h d n g ke vdi; Tudi, gidi, HA, ure, creatinin, uric, Hb, Albumin mau.
Kien nghj: Can t h e m nghien cilu vdi sd luong Idn hon va nhieu chi tieu nghien cilu hon ve chat lupng sdng d benh nhan suy than man giai doan CUOI, Ipc mau chu ky de tiep tuc nang cao chat lUdng sdng cho cac benh nhan nay.
Tai lieu t h a m khao
1 Hoang BCii Bao, Le Hilu Lol (2012) Nghiin cdu chat Iddng sdng d benh nhdn suy than man giai doan cuoi. Tap chi Y DUdc hoc sd 11, tr 22-30.
Nguyen Dung, Vd Van Thang (2014) Chat /i/6l|
sdng vd cdc yiu td cd liin quan d benh nhdn « • than giai doan cuoi d binh viin da khoa tinh SM Dinh. Y hoc cdng ddng sd 10+11, tr. 38-45. 1 Annees M et al (2011) !}ialysis-related factors afkcM quality of life in patients on hemodialysis Iran J Kidl^i
Dls5(1);9-M. f Bohlke M et al (2008) Predictors of quality of j
among patients on dialysis in southern Brazil % Paulo Med J 126(5); 252-256.
Mirhelen Mendes de Abreu, DavTd K. WalW, Ricardo C. Sesso, Marcos B. Ferraz (2011) Heair Related Quality of Life of Patients Becieving Hemodidi^
and Peritoneal Dialysis in Sao Paulo, Brazil: ^ Longitudinal Study Value in Health 14(5); 119-121.
Suk Jeong Lee et al (2015) Relationship between symptom clusters and guallty o f life in patients a stages 2 to 4 chronic kidney disease in Korea.
Applied Nursing Research 25(3); 190-196.
