NHAN XET M 6 T SO KHIA CANH CHAT LUONG CUOC SONG BENH NHAN HIV/AIDS DIEU TRj N 6 | TRU TAI BENH VIEN BENH NHIET Ddl TRUNG UONG N A M 2016
La Thi Nguy?t Minh', Ta Thj Digu Ngan^ Pham Thi Ngoc Dung^
Muc tieu: Nghien cuu mpt so khia canh chat luong cuoc song benh nhan HIV/AIDS dieu tri npi tni tai benh vien Benh Nhiet ddi Trung uong. Doi tuang vd phucmg phdp: Nghien cuu cat ngang tren 70 benh nhan HIV/AIDS. Ket qud vd kit lugn: Benh nhan co sue khoe the chat a miic cao nhat (60,9 ± 13,3 dilm); th^p nh4t la chat lirong cuoc song 6 khia canh nguon lire (43,2 ± 9,7 diem). Nam co sue khoe the chat va co nguon lire cao hon Nir (64,2 diem va 56,7 diem so vdi 51,9 va 50,9 diem). Benh nhan co trinh do cao dang, dai hgc co diem sue khoe tam than va khia canh xa hoi cao nhat (57,5 diem va 63,9 diem). Benh nhan suy giam mien dich nang co sue khoe tam than thap nhat (41,8 ± 13,6 diem), khia canh xa hoi thap nhat (46,7 ± 13,2 diem). Benh nhan dieu tri ARV > 2 nam c6 diem siic khoe the chat va nguon luc cao hem cac nhom con lai.
Tir khoa: HIV/AIDS, chat luong cupc song.
DAT VAN DE
Cho den nay, HIV/AIDS khong con la van de xa la vdi nhan loai, tuy nhien n6 van la van de sffc khoe toan cau.
Djch HIV/AIDS mdi xuat hien tff dau nam 1980 nhffng da nhanh chong lan ra toan the gldl. Tfnh den nam 2014, fren the gidi eo khoang 80 trieu ngffdi da nhilm HIV va khoang 40 trieu ngffdi da chet vi HlVt^J. Cho den thang 6 nam 2015, da cd 15,8 trieu ngffcii song ehung vdi HIV dffdc tiep can dieu tri khang vi rut. Mac dii vay, sff gia tang dang bao dpng ve ty le ngffdi nhiem HIV, kha nang tiep can va san co ciia dieu trj khang retrovirus boat tfnh cao cdn han che nen nhieu benh nhan nhiim HIV van chffa dffdc tiep can sdm vdi dieu t r P l
Viet Nam la mot trong nhffng nffdc co djch HIV phat trien nhanh nhat d chau k-^^. Theo so lieu eua Cue Phong, chong HIV/AIDS, Bp Y te, tinh den ngay 30/9/2014, ca nffdc cd 224.223 ngffdi nhiem HIV dang con sdng dffdc bao cao, 69.617 ngffdi chuyen sang giai doan AIDS dang
">Tnt&ng Bai hgc Y Ha NQL (2)B?nh vi^n benh nhi?t den Trung uang Ngay Dhan bai: 21/7/2016.
Ngay phan bl$n lOng: 28/7/2016.
Ngiy duy?t dang: 18/8/2016-
Ngiroi chju trach nhifm ngi dung khoa hgc: Lii Thi Nguy?l Minh.
TruangBai HQC YHa npi
Bien thoai. 01666354694 E-mail' lathinguyelminh@gmail com
cdn song va 70.734 ngffdi da tff vong do AIDS'^i.
Vdi nhutig tien bp gan day frong cac thff nghiem lam sang va dieu fri cho benh nhan nhilm HIV, sff song c ^ ciia nhiihg ngffdi benh nay da dffdc tang ro ret va chat Iffdng cupc song (CLCS) ciia hp da frd thanh frpng tam quan trpng doi vdi cac nha nghien a d i va cac nha cung cap djch vu cham soc sffc khoe. Tuy nhien, nhieu ngffcJi trong sd eac benh nhan HIV van phai vat Ion vdi cac van de xa hpi nhff ki thj, ngheo doi, tram cam, lam dyng chat va van hoa tin ngffdng ma eo the anh hffdng den CLCS ciia hp ca ve sffc khoe the chat l l n sffc khde tam than, xa hoi. Do vay, xac dinh cae yeu to tac dpng den CLCS d benh nhan HIV/AIDS la thffc sff (^n thiet va quan frpng de ffdc ti'nh ganh nang benh tati^i. Mpt so yeu to lien quan den CLCS d nhuTig ngffdi benh nhiem HIV da dffdc bao cao trong y van the gidi, chu yeu thupc bon nhom linh vffc: sffc khde the chat, sffc khde tinh than, khia eanh xa hpi va moi trffdngi^J.
Cho tdi nay, d Viet Nam chffa cd nhieu nghien cull tien hanh danh gia CLCS benh nhan HIV/AIDS. Do vay, ehung toi tien hanh nghien ciru de tai nay vdi myc tieu:
Nhan xet mpt so khfa canh ve chat lUdng cupc song ciia ngffdi benh HIV/AIDS dieu trj npi tnj tai Benh vien Benh nhiet ddi Trung ffdng.
8 6 - T R U Y i w N H l i M V I | T N A M * S 6 3(15) - 2016
D O I TUONG VA P H U O T ^ G PHAP
Doi tu'dng nghien cufu: 70 benh nhan nhiem HIV dieu tri npi t m tai khoa Vi rut - Kf sinh triing, Benh vien Benh Nhiet ddi Trung U'dng, tff tiiang 1/2016 den thang 4/2016.
Phu'dng phap: Nghien cirli cat ngang.
Cong cu va ki thuSt thu thap thong tin Bp cong cu dffdc sff dung de do Iffdng chat Iffdng cupc song ciia benh nhan dffa tren bp cau hoi WHOQOL - BREF, EQ - 5D - 5L, thang do 15D cd chinh siTa de phu hdp vdi dieu kien nghien eiilj lam sang.
Cong cu thu thap thong tin la bp cau hoi cau triic gom 3 phan: Dac i^em nhan khau hpc ciia doi tffdng nghien ciili (tuoi, gidi tinh, ndi d, nghe nghiep, trinh dp hpc van, ti'nh trang hon nhan, kha nang tai chinh, li do nhiem HIV);
dac diem lam sang (benh If dffdc chan doan, dieu trj cua lan nam vien nay, so Iffdng CD4, thdi gian dieu trj ARV);
diem chat Iffdng cupc song (sffc khoe the chat, sffc khde tam than, khia eanh xa hpi va nguon Iffc). Bo cau hdi gom 16 cau do Iffdng linh vffc: The chat (ve cac khia canh nhff di chuyen, cong viee hang ngay, cam giac dau, giac ngii, chan an), tam than (cang thang, lo lang, buon chan, nan long, cam giac dau kho, tpl loi), xa hpi (ki thi va phan biet ddi xff, yeu cau nghi viec, mong mudn tham gia cau lac bp, to chffc danh cho ngffdi nhilm HIV), nguon Iffc (kinh te ban than, djch vy y te dffdc ho trd, cham soc tff ngffdi than). Sd lieu dffdc nhom nghien cffu thu thap bang phdng van trffc tiep qua bp cau hoi.
Tinh tong diem ciia tiiTig benh nhan trong tffng ITnh vffc ve: sffc khoe the chat, sffc khoe tam than, xa hpi, nguon Iffc, sau do quy ddi diem tong cpng cua cac Unh vffc nghien eiili de danh gia CLSC chung ciia benh nhan ve thang diem 0-100 theo cong thffc sau^'^:
U"nh Oiem Mm
«
Di^m Max
y Uiang diem X - y
A
Thang diem 0 -100
A ' = ^ - ^ x 100^—^x100 y-x y-x
Xii ii so lieu: Sff ly so lieu bang phan mem SPSS 20.0.
Thdng ke mo ta bao gom: tinh ti le phan tr3m, gia tri frung binh, dp lech chuan. So sanh gia trj trung binh ciia cac nhdm benh nhan vdi eiing mpt dac tfnh phan bd khdng chuan bang each sff dyng phep tiiong ke Kruskal - Vi/allis. So sanh cd y nghia khi p < 0,05.
Dao dij'c nghien cihi: Ddi tffdng nghien cull dffdc giai thfch ve muc dich va npi dung ciia nghien culi trffdc khi tien hanh va chl dffdc Iffa chpn vao nghien cuXi khi co sff chap nhan hdp tac ciia ddi tffdng tham gia nghien cuti.
Ngffdi nghien ciru chi sff dung cac so lieu, thong tin thu thap dffdc phuc vu cho mue dfch nghien cffu, khong sff dung cho muc dfch nao khac.
KET QUA
Dac diem chung cua ddi tu'dng nghien ciiu Bang 1 : Dac diem nhan khau hoc
doi tu'dng nghien cufu
Oac diem
Gift tt'nii Trinh dp hoc van
Tuoi
Nghe nghiep
Tinh trang hon nhan
DiTcIng lay truyen HIV
Nam Nu-
< Tnjng hoc cd sd
> Trung hoc pho thong 20 - 29 tuoi 30 - 39 tuoi 40 - 49 tuoi
> 50 tuoi That nghiep Cong viec on dmh Cong VI& khong on dmh ChuS ket hon Ket hon/ Tai hon Li than/ li hon/goa Tiem diich ma hJy Quan he tinh due Khong khai thac du'dc Khac (tai nan, truyen mau, me sang con,...)
Sd liTcfng (n)
51 19 44 26 8 33 23 6 8 17 45 12 55 3 17 22 26 5
T y l e
(%)
72,9 27,1 62 38 11 47 33 9 11,4 24,3 64,3 17,1 78,6 4,3 24 31 37 8
Nhan xet: Ket qua bang 1 cho thay benh nhan nam chiem da so (72,9%), ti le benh nhan co cong viec khong on ainh chiem cao nhat (64,3%), chii yeu benh nhan ket h6n,tai hon dat 78,6%. Du'dng lay truyen HIV quan he tinh due chiem 3 1 % .
TRUYEN NHliM VIET N A M * SO 3(15) - 2016 - 8 7
Bang 2: Dac diem lam sang va mien djch ctJa benh nhan
Dac diem
Senhly du'dc chan doan trong qua trinh dieutn
So lu'dng CM TB/mm'
Thdi gian da dieu tri ARV
Lao (mang nao, phoi, xUdng khdp) Nhiem nam candtda Viem phoi do PCP Tieu chay Toxoplasma nao Viem gan (B, C, hoac dong nhiem) Khac*
> 5 0 0 350 - 499 200 - 349
< 2 0 0
< 6 thang 6 - 24 ttiang
> 24 thang Chu^ dieu tn hao gid
^ TV IS
13 11 9 1 3 17 16 2 5 10 53 15 7 17 31
18,6 15,7 12,9 1,4 4,3 24,3 22,9 2,9
?,i 14,3 75,7 21,4 10 24,3 44,3
nhat la viem gan B, C hoac dong nhiem (24,3%), benh nhan chu yeu d tinh trang suy giam mien djch nang - so Iffdng CD4 < 200 TB/mm3 (75,7%) va so benh nhan diim dieu tri ARV bao gid chiem 44,3%.
Diem chat lu'dng oioc song o i a nhom benh nhan Bang 3: Chat lu'dng cuoc song cua nhom
nghien d h i
Chat lu'dng cuoc song Trung binh Ttie chat 60,9 Tam than 46,3 Xa hoi 54,3 Nguon lu'c 42,3
SD 13,3 14,1 14,6 9,7
Min 21 0 0 11
Max 96 100 100 78
Nhan xet: Ket qua bang 3 cho thay chat lu'dng cuoc song cua doi tu'dng nghien cuU d khfa canh the chat co diem so cao nhat (60,9 ± 13,3); thap nhat la khfa canh nguon iiTc (42,4 ± 9,7).
Nhan xet: Bang 2 cho thay benh li du'dc chan doan dieu trj tai thdi diem nghien cutJ cua cac benh nhan cao
Bang 4: Chat lu'dng cuoc song theo mpt so dac diem nhan khau hoc
oiem chat lu'dng cuocsong
The chat Nguon lire
X(SD) X(SD) X(SD) X(SD)
64,2 (13,5) 51,9 (10,9)
45,8 (15,4) 49,6 (12,8)
50,9 (13,4) 56,7 (16,2)
40,1(8,7) 36,8 (8,7)
56,8 (15,9) 59,6 (13,2) 60,7 (13,3) 73,6 (14,1)
36,5 (11,6) 35,6 (12,1) 49,3 (14,7) 8,6 (12,3)
51,9 (4,7) 55,2 (14,3) 52,8 (12,3) 57,7 (4,1)
38,9 (5,6) 42,1 (10,7) 42,5 (9,9) 48,2 (3,4) Trinh do hgc van
59,1 (12,7) 63,8 (14,1)
44,5 (13,4) 50 (14,1)
49,3 (16,3) 61,5 (12,7)
40,7 (8,5) 45,3 (11)
Nhan xet: Ket qua bang 4 cho thay sir khac biet ve chat lu'dng cupc song giife cac nhom nhan khau hpc. Cac khfa canh chat lu'dng cupc song phan Idn deu khong co sir khac biet giu'a cac nhom (p > 0,05).
- TRUYfelNm6MVIETNAM*s6 3(15) -2016
Bang 5: Chai lu'dng cudc song theo mgt so dac diem lam sang
Digm chSt luong cuoc sSng'
Thg chat X(SD) 1 p
Tam than X(SD) p
Xahol X (SD) p
Nguon lu'c X(SD) 1 p Mtfc tf^ suy giam mien djch
> 500 TB/mm=
350-499 TB/mm' 200-349 TB/mm>
< 200 TB/mm>
72,9(10,1) 69,2(19,8) 60(12) 57,9(13,3)
0,61
54,2(25,6) 46,7(11,2) 68,3(12,6) 41,8(13,6)
0,03 65,4(12,1) 56,9(11,4) 56,9(20,7) 53,1(13,2)
0,82 50(4,7) 40(9,2) 46,7(10,5)
41,5(9,5) 0,64
Thdi gian dieu trj ARV Chuci dieu tri
< 6 thang 6-24 thang
> 2 nam
62,1(14,1) 61,7(12) 47,6(9,7) 63,2(13,9)
0,33 43(13,9) 53,9(13) 28,6(10,1) 52,9(16,9)
0,084 58,6(11,9) 47,2(14,6) 52,6(18,1) 53,4(15,2)
0,17 43,4(9,9)
40(7,5) 38,1(10,2) 44,4(10,5)
0,77
Nhan xet: Ket qua bang 5 eho thay sff khae biet chat Iffdng cupc sdng giffa cac nhom ve dac diem lam sang.
Cac khia canh da phan khong ed sff khac biet giu^ cac nhom lam sang (p > 0,05). Khia canh sffc khoe tam than CO sff khae biet giu^ cac nhdm (p < 0,05).
BAN LUAN
Nghien culi nay nham nhan xet mpt sd khfa canh chat Iffdng cupc sdng benh nhan HIV/AIDS dieu tri npi frii. Ket qua cho thay benh nhan Nam gldl cd sffc khoe the chat va nguon Iffc cao hdn Nff gidi. Tuy vay cac benh nhan Nff lai CO diem sffc khde tam than va khfa canh xa hpi cao hdn cac benh nhan Nam. Qua phdng van cac benh nhan Nff da sd lay benh tff chong nen nhan dffdc sff thong cam ciia mpi ngffdi, do vay ma diem sffc khde tam than co xu hffdng cao hdn Nam gidi. Nghien eiili ciia Nong Minh Vffdng eho thay, CLCS cua NO" gidi thap hdn Nam gidi d hau het cac kfiia canh (ngoai frff tff ch3m socy^l Ket qua thong ke ciia Cue Phong, chong HIV/AIDS cho thay, benh nhan NO" nhiem HIV nhan dffdc sff thong cam it hdn benh nhan Nam, bj len an nhieu hdn va bj ki thj va phan biet doi xff nhieu hdn™. NghiSn cffli cho thay nhom tuoi >50 tuoi cd diem chat Iffdng cupc song ve sffc Idioe the chat, khia canh xa hpi va nguon Iffc cao nhat trong cac nhom tuoi.
Nhom tuoi nay da phan da on djnh cupc song gia dinh va dffdc gia dinh ho trd. NghiSn ciru ciia Valentine U Odili va cpng sff d Tay Phi cung cho thay nhutig ngffdi khong c6 gia dinh ho trd c6 diem CLCS thap hdn so vdi nhutig ngffdi cd gia dinh img ho giiip dm\
Nghien ciili cho thay benh nhan co mffc dp suy giam
mien dich binh thffdng hoac suy giam khong dang ke cd sffc khoe the chat eao nhat (72,9 ± 10,1 diem) eao gap 1,26 lan so vdi benh nhan suy giam nang (57,9 ± 13,3 diem). Hdn nffa diem trung binh ve sffc khoe the chat tang cao dan theo thdi gian dieu trj ARV. Nhdm benh nhan dieu tri ARV > 2 nam eo diem sffc khde the chat eao nhat;
thap nhat la nhom dieu trj tff 6 - 24 thang. Viec dieu tri thuoc khang vi riit giiip benh nhan HIV/AIDS cai thien ve mat vi rut hpc, mien djch hpc va trieu chirng lam sang.
Lam sang cai thien, sffc khde the chat tang cao la tien de cho viec cai thien sffc khoe tam than.
Nhff vay, do Iffdng chat Iffdng d benh nhan HIV/AIDS la bien phap quan trpng gop phan danh gia hieu qua ciia cae can thiep dieu trj va cac chffdng trinh y te. Tff do giiip cho eac nha lam sang khong nhffng dieu tri het benh ma cdn xay dffng cac ke hoach de ho trd tdt hdn trong viec theo doi va quan ly benh nhan HIV/AIDS.
Nghien culi nay con mpt so han ehe nhff chffa xem xet den cac yeu to khac ciia benh nhan nhff hanh vi sffc khoe ciia benh nhan, eac tac dung phu ciia thudc, sff tuan thil diieu trj hay mffc thu nhap cua benh nhan. Day la lmh vffc can quan tam nghien cull de giup chung ta co cai nhin tong the ve benh nhan HIV/AIDS, tff do eo the de xuat them cac bien phap de cd the eham soc benh nhan HIV/AIDS tot hdn nffa. Vi v|y can co nhieu nghien culi sau hdn danh gia ve mol lien quan giffa cac yeu to nay va CLCS. Mat khac, nghien effti nay vdi c5 mau cdn nho, do dd han che viec suy rpng ra toan bp nhutig ngffdi mac, nhiem HIV.
T R U Y I N NHliM VigT N A M « S 6 3(15) - 2016 -
KET LUAN
Ket qua nghien cffu cho thay, benh nhan cd diem CLCS d khia canh sffc khde the chat dat mffc cao nhat (60,9 ± 13,3 diem); thap nhat la diem CLCS d khfa canh nguon Iffc (43,2 ± 9,7 diem). 6 nhom benh nhan suy giam mien djch nang cd diem CLCS d khfa eanh sffc khoe tam than thap nhat (41,8 ± 13,6 di^m), khfa canh xa hpi
thap nhat (46,7 ± 13,2 diem). Nhdm benh nhan dieu tii ARV > 2 nam c6 diem CLCS d Wiia canh sffc khde the chat va nguon Iffc cao hdn cac nhom con lai.
Ket qua nghien cffu cho tiiay benh nhan cd diem chat Iffdng cupc sdng ve the diat d mffc cao nhat, thap nhat la khia canh nguon Iffc. Khia canh ^ m li cd sff khac biet ro rSt giu^ cac nhom lam sang.
TAI LIEU THAM KHAO
1. UNAIDS (2015) Fact sheet 2015 (http://viAiwi/.un- aids.org/sites/defaulVfiles/medla_asseV20150901_Fact- Sheet_2015_en.pdf).
2. Harleen G., Amanda K, Mark H. et al. (2013), Health-related Quality of life assessment after Antiretrovi- ral tiierapy: A review of the literature. Drugs. 2013 May;
73(7): 651 - 672.
3. Bach Xuan Tran, Ari:o Ohlnmaa, Long Thanh Nguyen (2012), Quality of life profile and psychometric properijes of the EQ - 5D - 5Lin HIV/AIDS patients. Health and Quality of life Outcomes 2012, Vol. 10 Issue 1, pl32.
4. Bp Y te (2015), Bao cao Cong tac Phong, chong HIV/AIDS 6 thang dau nam 2015 va nhiem vu frpng tam 6 thang cudi nam 2015.
5. Naveet Wig (2006), The impact of HIV/AIDS on tiie quality of life, Journal of Medical sciences Indian, Number 1 - 2006, pp 3 - 1 2 .
6. L§ Minh Giang, Nguyen Thj Lan Hffdng, Nguyen To Nhff va CS. (2015), Chat Iffdng cupc sdng va mpt so yeu t d lien quan ciia benh nhan dffdc dieu trj methadone tai Hai Phong, Tap chi Nghien cuVyhoc,96 (4), fr. 114 -122.
7. Trffdng Van Binh, Dang Quyet Djnh, Thi Li Binh (2014). Danh gia sff khac nhau vie mpt sd dac diem lam sang, chat Iffdng cupc sdng ciia nhdm cai nghien heroin tai Benh vien Tam than va nhdm da cai heroin sau 12 thang tai cac phffdng d thanh phd Da Ning, Benh vien Tam than Da Ning (13/11/2014).
8. Nong Minh Vffdng (2015). Chat Iffdng cupc sdng ciia benh nhan nhilm HIV dieu frj khang vi mttai Ha Npi va Nam Dinh, Luan van Thac sy, chuyen nganh Y te eong cpng, Trffdng Oai hpc Y Ha Npi.
9. Valentine U Odlli, Isibhkhomhen B.I, Stella F.U, Azuka C.O.(2011). Determinants of quality of life in HIV/AIDS patients. West Africa Journal of Pharmacy, 22(1), 42 - 48.
REVIEWS SOME ASPECTS OF QUALITY OF LIFE OF PAHENTS WITH HIV/AIDS I N PATIENTS TREATMENT AT NATIONAL HOSPITAL OF TROPICAL DISEASES 2016
Summary HIV/AIDS IS no longer a new social issue in Viet Nam but the quality of life these patients is rarely mentioned.
This research was aimed to review some aspects of qual- ity of life of inpatients treatment at National Hospital of Tropical Diseases. A cross - sectional stijdy of 70 patients were proceeded. The toolkit is used to measure the qual- ity of life (QOL) of patients based on questionnaires WHOQOL - BREF, EQ - 5D - 5L, scale 15D that can be ed- itable to fit the conditions of clinical studies. Results
Key words: Quality of life, HIV/AIDS.
showed that, patients with the highest physical score of QOL (60,9 ± 13.3), gave the lowest social score of QOL aspects (43.2 ± 9.7). Men had greater physical health and had greater resources than woman (64.2 and 56.7 com- pared to 50.9 and 51.9). Patients with a college degree, have tiie highest mental healtii scores and sociality (57.5 and 63.9), sociality (46.7 ± 13.2). ARV patients over 2 years had higher physical healtii scores tiian other groups.
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