N g h i e n cvm Y hgc Y Hpc TP. Ho Chi Minh * T$p 20 * So 4 * 2016
KIEN THLfC THAI DO HANH VI VE VIEC HIEN THAN CHET NAO
TAI M O T S O C O N G D 5 N G T A I THANH P H 6 HO CHI MINHTmn Nggc Sinh* Li Hodng Ninh**, Hodng Thi Diem Thiiy***
TOMTAT
Muc tiiu: phan tich kieh tiide, thai M, vi zriic him than vd cdc yeu. toco lien quan vai hdnh zri him ihgn khi chei a ngu&i tren 18 turn & mgt so cdng ^ng tqi TP Hd Chi Minh.
Ddi tugng vd phuang phdp nghien cdu: phong van 1063 ngu&i riin 18 turn dm uoo bg cdu hoi tie diin.
Kei qud: 77% ddng y hiin thSn bdn timn khi chei, vd 63,8% ddng y hieh than ngu&i th&n Idii ehii. Cdc yai td'co tuang quan zj&i thdi do ^ng y him than ban thdn khi chB bao gom: dan tgc Kinh, kieh thiec diing ve rihu cdu hien ghep than, thdi do dung zii quan dirni nh&n dqo. Cdc yeu td'cd tuang quan v&i thdi do ddng y him than ngu&i thdn khi chei bao gdm: d&n tgc Kinh, Thiin (Jiiia gido, thai do dimg zii quan di&n nhdn dqo, thai d3 dun^
zii quan diem chia se. Li do (hirih ciia viec tie chdi hieh Id sg ngu&i nhd khdng ddng i/ vd sg "chei khong todn thdy". Yiu cdu diinh sau khi him Id sie cong bang.
Kei luan- kil qud nghiin cieu cho thdy da sd'ngu&i ddn iing hd him than, cdc chien luge tuyen truyin de n&ng cao kien thdc vd quan niim ciia ngu&i dan Id rai can thiei, vd la rien iang cho khoa hgc ghep tgng & nuac la phdt tri$i bin zririig.
Twr Idiod: ki^n thdc, thdi do, hiin than, chii nao ABSTRACT
KNOWLEDGE, ATTmiDEAND BEHAVIOR ABOUT BRAIN-DEATH KIDNEY DONATION OF COMMUNTUES IN HO CHI MINH CTTY
Tran Ngoc Sinh, Le Hoang Ninh, Hoang Thi Diem Thuy
* Y Hoc TP. Ho Chi Minh * VoL 20 - No 4 - 2016:80 - 85 Objectives: to explore the knowledges, attitudes about deceased kidney Donation after death and thefadors assodated with the decision to donate anwng the selective papulations in HoChiMinh dty.
Subjects and method: interviewing of 1063 people from 18 years old by questionnaire, the interviewees filled in themselves.
Main results: 77% and 63.8% agreed to donate thdr own kidney and the kidney of their relatives respectively after death. The factors assodated zoith Donation of thdr awn kidney comprised oft the population Kink, the good knowledge on ihe need cf transplantion and Donation, the good attitude c^altruism. Thenars assodated zvith Donation of the kidney of thdr relatives comprised of: the population Kinh, Catholism, the good attitude of altruism, the good attitude of sharing. The main reasons of refusal zvere the family constraint and ihe concept of "the whole body at death". The main requirement when a person donates was the egcdity cf organ using.
Conclusion: most people agreed with donation at HoChiMinh dty. We need education campaign to ameliorate the public point of zriew. The education mustbe the background fi}r the development of transplantation in our country.
Key words: knowledge, attitude, kidney donation, brain death
* Trucmg DHYD TP Ho Chi Minh, ** Vien ve sinh Y t^ cong c$ng, *** Tmong DHYK Pham Ngpc Thach Tdc gid liSn lgc: ThS. BS. Homing Thj Dilm Thiiy, DT: 0908235287, Email: [email protected]
Y H p c TP. H b C h i M i n h * T^p 20 * S£» 4 * 2016 N g h i d n cihi Y hpc D A T V A N D E
Tit cuoi th^ kj- XX, su bimg no cua suy th|in man t r ^ toan cau da lam cho nganh y hgc phai doi dau voi m6t tinh trang mat can bang cung - rau tram trgng ciia than ghep- mgt hien trgng dang dong hanh voi cac tien bg khong ngimg ciia khoa hgc ghep than. Van de nay da, dang va se tro nen m6t thach thiic doi vai siic khoe cgng dong tren toan the gioi. Vi the, cimg vol vi0c phat t r i ^ Id thuat ghep, hau h ^ cac quoc gia deu quan tam d&i khia canh xa hgi va phap li ciia van c£e nay de di iim giai phap cho nguon than ghep, tao co so de thiic day khoa hgc ghep than phat tri&i ben vimg. Mgt trong nhung rao can quan trgng ciia cong tac ghep th$n la linh tcang thieii hut nguon than de ghep. Nguon than tir nguoi cho s&ig rat gioi han trong khi do, nguon than tir nguoi dio chet nao chua dugc huy dgng het.
Ngay 29.11.2006, tai Vi|t Nam Luat hi&i, lay, ghep m6, bg phgn co Ihe nguoi da dugc Quoc hgi ihong qua... Tuy nliien, nhan thiic ciia cgng dong ve h i a i th$n noi rieng va cac bg phan co the noi chung con rat han che. Co rao can nao khac v^ kinh te, van hoa, xa hgi trong viec hioi than 6 nguoi Viet Nam?
' Tren co so nay, chiing t6i thuc hien khao sat KiCTi (hiic -Thai do ve vi?c hien t h | n aia mot so c6ng dong tai thanh pho Ho Chi Minh, tii do, g(^ phan de ra chien luge cu the de van ddng hien than trong dan chiing.
DdlTUtH^G-PHIJ'ONGFHAPNGHIENaJtJ - Thiet ke nghien ciiu: nghien a i u cat ngang mo ta va phan tich tren 3 nhom doi tugng: sinh vien, Thien Chiia giao, Phat giao.
- Co mau: 1063 ngucri.
- Thoi gian: thing 4 - 6 nam 2011 - Dja diem nghien ciiu:
+ Thien chiia giao: tai nha tho Thii diic: 250 + Phat giao: tai chiia Thien Lam - Quan 8:250
+ Sinh vi&i: truong DH Luat Vp Ho Chi Minh, DH Y khoa Pham Nggc Ihgch: 568
- Phuong phap: phat phieu cau hoi ty dien - Phuong phap thraig ke: tan so va ti le dugc sii dung cho bi&i scf dinh tinh; b i ^ s6 tuoi co phan phoi khong binh thuong n&i trung vj va khoang hi phan vj dugc sir dung. Chi binh phuong dugc sit dung de xet moi lien quan giiia dac tinh mau nghien cihi, kioi thiic, thai do voi viec h i a i tham. So do ket hgp PR dugc sii dung d^ do lucmg do Ion moi li^n quan giiia bieh so hien t h | n va dac tinh mau nghien aiu, Idai thiic, thii do. H5i quy Poisson va tiiy chgn robust dugc sit dung de ki&n soat biSn so gay nhilu nhu d§c tinh mau nghien aiu.
K E T Q U A
Dac diem doi t u o n g n g h i ^ cijru - Tu.6i hrung vj: 22 (25p =20,75p= 32) - Gioi: nam 413 (39 %); nii: 645 (61%) - Hgc van: pho thong 260 (24,62 %); dai hgc 782 (74,05 %); sau dai hgc 14 (1,33 %)
- Dan tgc: Kinh 986 (93,82%); Hoa 37 (3,52 %) Khmer 16 (1,52%), Khac: Cham: 12 (1,14%)
- Ton giao: Phat 292 (25,6 %); Thien Chiia 281 (24,6%);Th6 6ng ba 330 (28,9 %); khong theo m6t ton giao nao 227 (19,9 %); khac 10 (0,8 %)
- Tmh trang hon nhan: co gia <finh 231 (21,73
%), dgc than 832 (78,27 %)
- Kinh te: giau 37 (3,51 %); kha 225 (21,37 %);
trung binh 681 (64,67); ngheo 110 (10,45 %).
- Nghe nghiep:
Bdng 1: Phdn bd'nghi nghiep Ngh@ nghigp
HSSV CNV Npitro' Bu6n b ^ nho Lao d$ng phd thdng
ChG doanh nghiSp Khac Nong d3n
S6liF0>ng 707 136 59 62 39 29 29 3
67,14
%
12,82 5,6 4,94 3,7 2,75 2.76 0,28
N g h i e n cuu Y hpc Y Hpc TP. Hb Chi Minh * Tap 20 * So 4 * 2016 Phuang tien ti^p c | n thong tin v e hien
than
Bang 2: phuang tiin tiiJ3 can thong tin PHUONG TIEN
Tmyen hinh Sdch
Bio Ngu^i khSc Ngtfdi ihdn bj benh
Radio Chi^a bao gid' nghe
Sdluyng 649 Sii 639 338 168 105 38
61
%
51 50,5 31,6 14,8 9,8 3,6 K^t q u i ve Iden thufc
Kien thdc ve rihu cdu hien - ghep than cua xd hdi
Cau 14. Suy than nang se chet neii khong dugc lgc mau hay ghep than
Cau 15. Nhung nguoi hi suy Ihan hien nay dang rat ran CO nhiing nguoi cho th?n de dugc ciiu SOTig. Anh/chj 6r^ / ba CO biet ve ttior^ tin nay.
Bang 3: kei qud kien thiec zie nhu d&u ghep than ciiu
Ciu 14 cau 16
Sd tra Idi
(%)
1049 (98,2%)
1051 (98,4%)
DOng: Sd luvng
(%)
988 (94,2%) (86,1%)
Sai: sd l u ^ g (%) 61 (5,8%)
146 (13,9%) Nhqn xit: da so nguoi dugc khao sat nhan thiic dugc suy than la b^nh nang va can dugc thay the than.
Kieh thiic ch^ nao
Cau 16. Ch^t nao la tinh tr^ng tim con dgp nhimg nao hoan toan h u hai, khong con kha nang phyc hoi
Cau 17.Chet nao thuang xay ra trong nhiing cai chet "bat dac ky tii" nhu: tai nan, tai bi&i match mau nao,... Anh/chi co biet dieu nay khong?
Bdng 4: KM qud kien thdc vi ch^ ndo cau
Cau 16 cau 17
Sdtiai»i
(%)
1046 (97,9%)
1052 (98,5%)
Ddng: S6 l u ^ g
(%)
880 (84,1%)
856 (81.4%)
Sai:s^
luong (%) 166 ( I ^ W )
196 (18,6%)
NhSn xd: da so nguoi dugc khao sat dong y vod quan niem chet nao la bat hSi phuc va linh huSng xiy ra la dot ng6t.
Ki^ thdc dung vi nhu c&u hiin ghep than: khi tri loi "diing" cau 14 va "co" cau 15
Kim thuc dung zie chii ndo: khi tra loi "diing
"cau 16 va " co" cau 17
Bdng 5: Kei qud kiSh thdc diing zie nhu cau ghep than NOI DUNG
Nhuc^u Chet ndo
Setrild1(%) 1046 (98%) 1052 (98,6%)
S6ddng(%) 866 (82,8%) 877(83,4%)
SisaiasS 179(17,2%) 176 (16,6%) Nhdn xet hon 80% nguoi dugc khao sat c6 ki&i thik diing ve nhu cau hi&i -ghep than va ve chet nao
Ket qua ve thai dd
^^uin diem nhdn d^o.
Cau 19. Viec cho than cho nguoi hi faenh la mgt nghia cii nhan dao?
Cau 20. "Khi nguoi fa chet di nhung con mot bg phein tren ca the dem cho lai cho mgt nguoi khac thi giong nhu than xac van con tren coi doi nay.Ong ba anh chi nghi sao ve quan diem nay?
Bang 6: Kei qud thdi do zH quan dimi nhdn dgo cau
19 20
S d M U i
1062 (99,9%)
1054 (99,1%)
Rit dins
364 (34,3%)
231 (21.9%)
Ddngy
654 (61.6%)
573 (54.4%)
Khdng 66ng^
38 (3.6%)
230 (21.8%)
Rit'l
Uidng>
adngt;
6 (0.5%)
20 (5.1%) Nhdn xet: ti ^ nguoi dong y hi&i tluin la nghia d i nhan dao rat cao (95,9%). Ti le cho r5ng hi&i CO quan khi chet giong nhu than xac con tren coi doi thap hon (76,3%).
i^tan diem chia se
Cau 21.Viec tuyen tmyen gjao due hioi than tren cac phuang tien thong tin dai chiing co can khong?
Cau 22. Viec h i m fhlin se d l dang hon neii dxtac ban bgc truoc vdi nguoi than, On^ ba anh chi CO nghi rang nunh se ban bac vai nguoi than khi quyet djnh khong ?
82
Y Hoc TP. H o Chi Minh * Tap 20 * So 4 * 2016 Nghien ciru Y hoc Cau 23. Qng ba anh chj co nghi rang minh
ciing CO the c6 Mc can ducyc ngucri khac cho than Bang 7: KH qud thdi do zij quan diim chia se
cau
cau 21 Ciu 22 Cau 23
Sdtr^loi
(%)
1066 (98.9%)
1057 (99%)
1044 (97.7%)
06: Sd luong 957
(%)
(90,6%) 971 (91,9%)
893 (85,4%)
Khdng*: s6 iu-gpng (%)
99 (9,4%)
86 (8,1%)
151 (14,6%)
*trd lai khong biei = Ididng
Nhgn xet: ti le nguoi dong y voi viec tiiuc hien tuyen truyen hioi than tren phuang tien thong tin dai chiing la 90,6%.
Tl 1? nguoi quyet dinh ban bac vdi nguai thanla91,9%>.
Ti le nguoi ngjii rang ban than rrunh cd liic ciing CO the bi suy than la 85,4%.
TTifli do diing zie quan dimi nhan dqo: khi tra loi
"dong f hoac "rat dong y "2 cau 19,20 Thai do dung vi quan ^em chia se: khi tri loi
"cd" 3 cau 21,22,23 Bdng 8: Kii qud ihdi do diing
SCIDUNG Nhan dao Chiase
S d t l t i a i ( % ) 1053 (99%) 1035 (97,4%)
sa diing (%) 784 (74,4%)
782 (76,6%)
S6sal(%) 269 (25,6%)
263 (24,5%) Nhan xet: ti 1? nguoi cd thii do diing ve quan di&fi nhan dao; ti le nguoi co thii do diing ve quan diem chia se la 75,5%.
Thai dp dong y hien thSn khi chet va cac yeu to tuang quan
Thdi do ^ngi^ him thdn
Bdng 9: Kei qud ue thdi do bie'n than khi diii N$i dung
Hidn than cua ban than Hien than cua
ngudi than Sdtiaidf
1020 (95,5%)
1005 (94,1%)
s d n g j 785 (77%):
641 (63,8%):
Khdng d6ng
**
235 (23%)
364 (36,2 %)
Nhqn xet: ti le ngucri dong y h i m than ban than khi chet la 77%>
Ti le nguoi dong y hien thgn nguai than khi chet la 63,8%.
Cdc yeu to tuang quan dm viec hi^ thgn khi chSi
Bdng 1ft Md hinh Hdi qui da bieh giUa cdc bieh sd' kim thiec, thdi dd, dgc tinh mau vd thdi do him than bdn thdn khi ch&:
M d n than ban than CdiddnthtFcaCingvenhu
cau Co thai do dOng vd quan
diem nhan dao Dan tdc Itinh so voi ddn
tdc khde
PRdldu chtnh
1,15 1,30 1,38
(KTC 9S%) 1,03-1,27 1,17-1,43 1,11-1,72
P 0,01
<0.001 0.003 Nhdn xit: khi phan tich da bi&i, dan t^c Kinh, nhimg nguoi co kien thiic diing ve nhu cau hien-ghep than va thai do diing ve quan diem nhan dao cd ti Ie dong y hieh cao hon co y nghia thong ke.
Bdng 11: M6 hinh Hdi qui da bim giu:a cdc bi^ so kim thiec, thai do, dqc tinh mau vd thdi do him than ngu&i than Idii chei
Hien than ngudi than Co thai dd dOng ve quan
d i ^ nhan dao Cd thai dd dOng ve quan
diem chia se Tdn gido (so vdi Ittidng
tdn gido) -Phat -Thien Chua - Thd dng bd-ldiac Ddn tdc kinh so vdi ddn
tdc khac
PR didu chinh
1.44 1.26
1.07 1,15 1,02
1,41 TRTfc95%)
1,24-1,66 1,09-1,45
0,93-1,24 1-1,3 0,9-1,2
1,06-1,87 P
<0,001 0,001
0,34 0,04 0,73
0,016 Nhdn xet: khi phan tich da bien, dan tgc Kinh, nhung ngu6i theo dao T h i ^ Chiia, nhiing ngucri CO fhii do diing v§ quan di&n nhan d^o va quan di&n chia se cd ti 1$ dong y hien cao hon cd y nghia thong ke.
*trd l&i khdng biii = khdng
Nghien ctm Y hpc Li do khong dong y hi^n t h ^
Bdng 13: Li do khdng ddng y hien th&n
Y H p c TP. H o Chi M i n h * T a p 20 * So 4 ' 2016
Li do Ididng hiin than Gia dinh khdng ddng y
S?
Khac*
Tdn giao
S6 lupng 185 116 70 20
44,8
%
27,8 19,6 4,8
*U do khac: muon giu; nguyin ven co the (45), sg mai tdng di&m trid), sg sie dung khong dung muc dich (13), thii tuc kho khan (4), khong tin heang (1).
Nhqn xet li do chinh khong dong y hioi than la sg gia dinh khong dong y (44,8%).
Cac yeu cau k h i high than (N= 155) -Congbang: 109 (70,3%) -Tai chinh: 30 (19,4%) -Khic: 16 (10,3%)
+ Cd chinh sich im tien cho ngudi hi&i: 08 + LTU tien nguoi tre va tre em: 04 + Dugc biet nguoi rth|n: 02 + Hgi y gja dinh: 02 B A N L U A N
O nudrc ta, tnmg binh moi ngay cd 30 ngudi tu vong vi tai nan giao thong. Nhiing ngutri nay hi vong trong tinh trang ch^t nao, nghia la hoan toan khong co kha nang phuc hoi dii tim van con dap va tuoi ddi con rat tre. Neii nan nhan va gia dinh dong f hioi tang, day se la nguon tang qui gii de ciiu song nhiing nguai suy fiian giai doan cuoi ndi rieng, va suy tang man ndi chung. Tuy nhien, nhan ihiic a i a cgng dong ve hien than ndi rieng va cac bg phan co the noi chimg con rat han che.
Vi chua CO n h i ^ thong tin ve hien t ^ g t ^ Vift Nam, chiing toi chgn 3 dcfi tugng tren de khao sat vi muc dich thuan ti^, vdd gii Ihuyet rang day la 3 dcfi tugng de ti^ can nhat de cd ..
chuong tiinh can thiep sau nay. Dan so nghien cihi a i a chiing toi chua co tinh dai dien cho dan so Viet Nam, day la khao sat budc dau de tao tien de cho cic nghien ciiu khac quy mo hem.
Nhieu tac gia tren th^ gidi'^'^> ciing chgn sinh vien V£i doi tugng ton giio de can t h i ^ , dac Met,
sinh vien la nhom doi tugng tre, cd tu tuong thoang va de tao hieu iing tiiii phat do cd miic do trao doi cao.
Kien thiic diing ve benh than va chet nao khong thSp hon ding kg so vdi k ^ qua nghi&i ciiu 6 cic nuoc phat trien. Theo khao sit da quoc gia a i a ManninenW, cd 92,7% nguoi cd Idai Ihiic ve su Ihieii hut mo tang de ghep; 66,5% dong f rang ban than hg cd the la ngucri phai nhgn th§n;
64%) cd Hen thiic diing ve chet nao.
Trong nghien ciiu a i a chiing toi, ti 1? nguoi dong y hien than b i n than k h i cao. H le dong y hioi than ciia nguoi than Ihap hon, phit hop vdi cac ngihien a i u khac. Ket qua ciia chiing toi khong phu hop vdi nhieu tic gia nhgn thay hanh vi Men than cd tucmg quan vdi nghe nghiep, miic do kinh te, Id&i ihiic diing ve chet nao va su ban bac vdi nguoi thSn'^'. Trong so nhiing ngudi da tim^g ban bac ve hien than trong gia dinh CO 77% nguoi hi&i, trong khi do chi cd 42%
dong y hioi 6 nhdm chua iimg thao luan'*'.
Hanh vi hioi than trong nghien ciiu nay thuc chat chi la hanh vi "ao". Theo cac tic gia, con so that ciia Yden tang chi con 1/3-1/4 con so khio sit dugc do six tic dgng chii yeit tii nguiri nhaW. Tuy nhieri, ket qua tren ciing da cho thay su ddn n h | n ciia ngudi Viet Nam ve hi&i tang kha tot, la dgng luc thiic day cac chuang trinh van dgng irien t?ng hoat dgng. Ngoai ra, doi hoi chinh aia nhiing ngudi dong f hien tang la
"cong bang ", trong khi ddi hdi ve tai chinh chi chiem 19,8%, thap hon cac tac gia tren thegjoiP'.
Ve doi tugng can dugc tuyen truyen him than, da so dong y dua vao giio due tir cap 3, tuy nhien so nguoi khong dong y tuy&i truyen con cao (14,6%). Day ciJng la nhdm can dugc quan tiim k h i o sit sSu, tuy khong phSila da so, nhimg hg cd the tao anh huong kh6ng tot cho cgng dBng.
i d T L U ^
Nghien cihi ciia chiing toi tai thanh pho Ho Chi IWQnh ve kiai thiic, thii d6 va hanh vi v^
hien than cho thay cic ket qua kha quan vdi 77%
84
Y H p c T P . H o O u M i n h * T a p 20 * So 4 * 2016 N g h i e n ciiu Y hpc dong y hi&i flian ban than khi chet, va 63,8%.
dong y hiSi fhan ngudi than khi chet. Cd tren 80% ngudi dugc khao sit cd kim thiic diing ve iinh hinh benh ihgn hifen nay trong dan so va nhu cau gjiep than. Cd hon 80% ngudi dugc khao sit cd ki&i thiic diing ve ch^t nao. Cd 75%o ngudi dugc khao sat dong y vdi quan diem nhan dao va chia se khi hien than. Cac yeu to cd tucmg quan vol thai do dong y hien than ban than khi diet bao gom: dan tpc Kinh, kien thiic diing ve nhu cau hi&i ghep than, thii do diing ve quan diem nhan dao. Cic y ^ to cd tuong quan vdi thai do dong y hi&i than ngudi than khi chet bao gom: dan tgc Kinh, Thien Chiia giio, thii do diing ve cjuan diem nhan dao, thii do diing ve quan di&n chia se. Li do chinh cua viec tir chSi hien la sg ngudi nha khong dong y va sg "chM khdng todn ihay". Yeu cau chinh sau khi h i m la su cong bang.
Chiing ta can cd them nhieu nghien ciiu tren nhieu doi tugng khic trong dan chiing de cd nghien ciiu co tinh dai dien hem cho nguoi
Viet Nam. Ket q u i nghidn ciiu cho tiiay da so ngudi dan iing hg hien than, cac chien luge tuyen truyen, can thiep la rat can thiet, va la n ^ tang cho khoa hgc ghep tang 6 nuoc ta p h i t trien ben viing.
TAI UtU T H A M K H A O
1 Manrunen DL, Evans E W (198^, PubLc attitudes and behaviorregarding organ donation. JAMA.; 253(21): 3111-15.
2. Matas. AJ, Suftieriand D E R (2005) The importance of innovative efforts to increase o ^ a n donation.
JAMA.;294(13):1691-1693.
3 PHce D. (1994) Living iddney DonaBon in Europe: Legal and ethical perspectives- the EUROTOLD Prqect, Transpl Int 7 (SuppU):S665-S667.
4 Siminoff L.A, N.Ciirdon, J. Hewlett (2001): Faclots influencing femiUes's consent for donation of solid organ for transplantation. JAMA.;266(l);71-77.
5 Weaver M, Spigner C, Pinela M, Eabun KG, Allen MD (2001):
Knowledge and opiruoriB among urban h i ^ sdiool students;
pilot test of a health educatiori JAMA; 286:71-77.
Ngdy nhgn bdi bdo- 10/11/2015 Ngdy phdn biin nh^ xet bdi bdo: 25/11/2015 Ngdy bdi bdo duac dang: 05/12/2035
