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,

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

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

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%,

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

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

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

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

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

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

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

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

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

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

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

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