Nghien cuu Y hpc Y Hgc TP. Ho Chi M i n h * Tap 20 * Sd 4 * 2016
GHEP THAN CHO NGl/dl NGHEO: GIAI PHAP KINH TE
Die Thi Ngoc Thu*, Trdn Nggc Siith'
TOMTAT
Dat vdn de: Ghep th&n Id mgt tiong cdc phieang phdp diiu tri thay the'co hiiu qud nhai cho nhimg berA nhan (BN) bi suy than mqn giai doqn moi (STMGDC). Tuy nhiin, trong hodn cdnh him tqi cita Viet Nam, klwng phdi b&i ky nguai henh ndo cdng cd the chon lua dugc phucmg phdp diiu tri ndy. Can phdi co nwt gidi phdp tich cue detdi cd nhieng ngu&i binh cd the dion lua dugc phucmg phdp dOu tri tdi uu nhai.
Tu lieu vd phuang phdp nghien cdu. Phucmg phdp nghiin cdu tien cthi loqt tne&ng hop. Tu lieu Id cdc tne&ng hgp BN suy than mqn giai doqn mdi, khdng dii khd ndng kinh te nhieng a? th^chgn lua ghep than la phuang phdp diiu tn thay thi'thdn tqi Binh zhen Chg Rdy trong ndm 2004,2008,2011.
Kei qua: 3 tne&ng hgp benh nhan ngheo, STMGDC, dugc ghep than tqi Binh zriin Chg Rdy (BVCR) trong nam 2004, 2008, 2011. Tudi tiung binh 24,33±3,77 tudi (20; 30), nd:nam = 1:2; 2THld sinh viin, hgc sinh vd 1 Id CNV; ngu&i cho la ngu&i than trong gia ^nh (em zm cha me ruot). IGnh tegia dinh Id lam nong budn ban nlw Dieu kien deghep than nha su hd trg dut xd hgi. Nghi nghiep him tqi Id gido zriin, nh&n zriin vdn phong, CNV.
Creatinin-huyei thanh hiin tgi Id 1,2; 2,2; 1,4 mg%
Kit ludm Sau ghep than ngu&i binh c6 thi'tra Iqi lioi srnig, sinh hoqt binh thu&ng trang gia dinh vdcdM gop phdn lao dgng tqo ra sdn pham ddng gdp cho xd hdi Nhung mudn tham gia ghep than noi rieng vd ghep tqng ndifhung, kinh tela vdn di quyii djnh chinh, can phdi co mdt ki'hoach diuan bi hodn chinh thi tai cd moi ngiedi binh lieu co thi'tham gia mdc ghep.
Tit khoa: Ghep than, cdc nu&c dang phdt trim.
ABSTRACT
RENAL TRANSPLANTATION FOR THE POOR: THE SOLUTION TO THEIR FINANCL^L TROUBLES Du Thi Ngoc Thu, Tran Ngoc Sinh * Y Hoc TP. Ho Chi Minh * Vol. 20 - No 4 - 2016:32 - 35 Background: Renal transplantation is the best effectively replacement treatment for End Stage Chrome Rmal Disease (ESRD) patients (pts). But there are not any the ESRD patients can get renal transplant.Wliat shxmld we do to get renal transplantation far all of them?
Materials and methods Prospectizx study. The patients arc the poor ESRDs, but they could dwose tiie renal transplantation treatment at Cho Ray Hospital in 2004,2008,2011.
Results there are 3 patients to get renal transplantation at Cho Ray Hospital in 2004, 2008,2011. Mean age zoas 24.33±3.77ys (20; 30), fimale: male = 1:2; 2/3 pts were students and 1/3 was gaoerment official; The donors are their sister, father, mother. Their family occupations are farmer and hawkers. Hospital fees and thefiesfor tieatmmt after transplant zoere sponsored by the collection projects for charity. Their ocmpations are teacher and officials now. Their serum Creatinine are 1.2,2,1 and l,4mg/di
Conclusion The patimts luill hazx the best qualities of life after rmal transplantation and they could make the produce and opportuniti/ to socialize with new colleagues. But the economy is the detennining factor in transplant, zve should have the fully plans for that.
Key words: renal transplantation, developmg countries.
* Khoa Ngogi Tiet Nieu, D o n vi Dieu phoi BVCR
Tac gid lien lac: BS Du Thi Ngpc Thu, DT. 0916191016, email: dpthi.
32
Y Hpc TP. Hh Chi Minh * Tap 20 * Sd 4 * 2016 Nghien ciiu Y hpc
DATVANDE
Ghep thgn la mot trong cac phuong phap diJeu trj thay the co hieu qua nhat cho nhiing benh nhan (BN) hi suy than man giai doan cuoi (STMGDC). Va chi phi ghep than theo thong ke aia the gioi thap hon nhieu so voi than nhan tao va tham phan phiic mac*'*. Tuy nhien, trong hoan c^inh hien tai cua Viet Nam, khong phai bat ky nguoi benh nao ciing co the ehpn lua dupe phuang phap dieu tri nay vi nhieu yeii to nhu khong CO nguoi hien than hay khong dupe bao hiem y te ho trp 100%. Do do, can phai tim giai phap tich eye nhat de tat ea nhimg nguoi benh STMGDC CO the chpn lua dupe phuong phap dieu tri toi uu nhat.
TUUEUVAPHL/ONGPHAPNGHIENCLJIJ Phuong phap nghien ciiu tien ciiu loat tntong hpp. Tu Heu la cac truong hpp STMGDC, Bdng 1: t&m tdt thdng tin chung cua binh nhdn
khong dli kha nang kinh te nhung co the chpn lua ghep than la phuong phap dieu tri thay the than tai Benh vien Chp Ray trong nam 2004, 2008,2011.
KET Q U A
3 truong hpp benh nhan ngheo, suy than man gjai doan cuoi, dupe ghep than tai Benh vien Chp Rly (BVCR) trong nam 2004, 2008, 2011. Tuoi bnmg binh 24,33±3,77 hioi (20; 30), nit:nain = 1:2; 2 TH la sinh vien, hoc sinh va 1 la CNV; nguoi eho la nguoi than trong gia dinh (em va cha me rupt). Kinh te gia dinh la lam nong, buon ban nho. Dieu kien de ghep than nho sy ho trp ciia xa hpi. Nghe nghiep hien tai la giao vien, nhan vien van phong, CNV. Creatinin- huyet thanh hien tai la 1,2; 2,2; 1,4 mg%. Chi tiet xin xem bang torn tat thong tin.
Cac thdng tin Tuoi G\6i\ tinh
Dia chi Nghe nghiep Kmh l l gia <Jinh Anh em trang gia dinh
Ngay ghep Ngu'6'1 hien C^ch h5 tro' itinh tg
Thar ghep cap s6m CN thin phuc hti s&m
Thai ghep mij$n Bien chirng khac Crealinin-HTh hi^n tai
(1) Dang Van B 23t Nam Binh Thuan sinh vien cao ding
Lam nong 7 9/12/2004
em mot - Mi§n vi&n phi wd chi phi phiu thuat - Su' dyng c6ng thtl-c thuoc CsA, /\ZA,
Pred.
- Xin h6 tro' thu6c tO cac cong ty DP Kh
Co Kh Kh 1,2mg%
(2) Trin Thj Ngoc Th.
20t nCp TPHCM Hoc smh Buon ban nho
2 15/7/2008
m^mot
• Miln vi#n phi v& chi phi phSu thu3t.
- SO dung cong thirc thuoc CsA, /VZA, Pred.
- Co SU' quyen gdp cua H5i chQ- thiip do va Hgi phy hu^h hgc sinh
Kh Kh 06 Lao phoi, cot song
2,2mg%
(3)DdVi#tT.
30t Nam BRVT CNV Buon ban tap hoa
2 14/6/2011
cha mot Xin tiln trgn bao
C6ng an
The dich HP N6 Kh Kh Viem phoi
1,4mg%
BAN LUAN VA KET LUAN
Dieu tri thay the t h ^ eho nguoi benh suy than giai dogn cuoi eo the ehpn lua mpt trong 3 phuong phap la CTNT, TPPM hay ghep than.
Chpn lua phuong phap dieu tri nao con tuy thuoc vao tinh trang sue khoe chung, co tang hi&i hay khong? Va quan trpng nhat la kinh te
ciia nguoi benh. Nhung du chpn lua phuong phap dieu tri nao thi kinh t^ van co vai tro chii chot trong viec dieu tri sau ghep. Tai An Do va Parkistan (2013)'"^' da de cap den chi phi dieu tri thay the than cho nguoi benh suy dian giai doan cuoi trong phuong phap dieu trj bang CTNT hay tham phan phiic mac (TPPM) va ghep than. Hp nhan thay rang, chi phi cho dieu tri tang len 40%.
33
Nghien ciru Y hpc Y Hgc TP. Hb Chi M i n h * Tap 20 * So 4 * 2016
Tac gia Paul M.J. va cs (2008)P> cung da de cap den kinh phi eua viec dieu tri thay the than 6 cac nuoc dang phat trien, ehi phi cua loc than tai nha se thap hon tai bung tam. Parkistan, 1980W tren 90% nguoi bi suy than man giai doan cuoi khong CO dieu kien de dieu tri thay the than, vi the Chinh phii da ehi tra toan bp chi phi ciia dieu trj thay the b5ng than nhan tao hay ghep than (tu nguoi cho trong gia iSnh). Hien tai co 600 BN CTNT mfii ngay, moi tuan co 7-10 TH ghep than til nguoi cho song. Ghep thSn thi thich hpp hon, nhmig van de la khong dii nguon tgng hien. Do do hp da chii trpng deh viec phat trien dpi ngii cac nha Than hpc va tang cuong diam soc siic khoe ban d^u de phat hien som benh than man.
Tai Viet Nam ehua co nghien euu chinh thiic ve chi phi phai chi tra cho viec dieu tri thay the than, tuy nhien qua nhiing tinh toan hang ngay tai BVCR, so tim ngiroi benh phai thanh toan cho viec dieu tri thay the than:
- Doi voi TPPM tong toa cao nhat la 14 trieu dong/thang- Nguoi berth dupe BHYT chi tra cao nhat la 95% (BHYT cho nguoi ngheo), thap nhat la 80%. Ti le hp ngheo >50%.
Bdng 2: Chi phi tru&c ghep vd sau ghep than cua binh
Doi voi TNT, tong toa 13-15 trieu dong/thang. Nguoi benh tu chi tra khoang 800.000-900.000 dong/thang, chua ke chi phi chi tieu ca nhan cho mSi Ian CTNT.
- Doi voi ghep than tong toa tu 5-10 trieu (trong nam dau tien chi phi se rat cao), sau do tW so tien chi tra se giam dan tiiy theo miic dp on dinh ciia nguoi benh. BN tu dong 1-5 trieu dong/thang, tiiam chi co mpt so it nguoi dong tien <1 trieu dong/tiiang.
Tai sao phai de cap d8h ghep than cho nguoi ngheo? Boi vi ghep than se mang lai nhieu Ipi ich cho ban than nguoi benh, gia dinh va xa hpi nhu:
+ Chat lupng song tot hon eho nguoi benh STMGDC, nhat la 6 doi tupng duoi 50 tuoi, dang trong dp tuoi lao dpng.
+ Ghep than se lam giam dupe ganh nang cho gia dorih va xa hpi, nguoi benh co the tham gia cac hoat dpng lao dpng, tao ra aia eai v|t chat dong gop eho xa hpi.
+ Va tiet kiem rat nhieu cho ngan sach Nha nuoc phai chi cho v i ^ dieu trj hang thang (bang 2).
nhdn STMGDC Cdc thdng tin
Nam gh^p Nghe nghiep hien tai
BHYT Tien thuoc hang thang:
+ BHYT tra + BN tLF dong D6i vif\ TPPM Bfii vol TNT Tiin tiet ld§m cua quy BHYT
(1)E)iingVanB 2004 Gido vign X6a doi giam ngh6o
3.800.000 3.040.000 760 000
(2) Iran Thj Ngpc Th.
2008 Nhan vien van phong
Ty nguySn 9.000.000 7.200.000 1 800.000 tdng toa cao nhSt la 14 tri^u d6ng/thang
t6ng toa 13-15 trifeu d6ng/th^ng 10trAhdngx120 tiling
=12.000 000.000 ty
=120.000.000/nim
6,81r/thang x 84 thang = 571.200.000 tr = 61.600.000/nann
(3)D6Vr4tT 2011 CNV Can ngh6o 7.300.000 6.909.000 391.000 Ngu^i b$nh khdng the tham gia cdc ho^t dpng lao
dgng x3 hdi 7tr/thang x 48 thang =
340.368.000 tr = 84.000.000/nam Trong dieu kien xa hpi Viet Nam hien nay,
mpi nguoi dan khi dieu tri benh da phan deu can CO su ho trp eiia BHYT. Nhu vay, chpn lua phuong phap dieu tri nao de tiet kiem dupe toi uu nhat ngan sach Nha nuoc thi chi c6 ghep than. Nhung lam the nao de eho tat ea moi nguoi benh STMGDC deu eo tiie chpn lua dupe
phuong phap dieu t 4 thay the than la ghep than? Can phai co:
- Nguon tang iden va eo su hoa hpp mien dieh cao cong tiiiic thuoc re tien (Neoral Sandimmun + Azathioprine + Prednisolone),
Cac dieu kien khae nhu:
+ Tu ban than phai co mpt so tien toi tiiieu,
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Y Hoc TP. H o Chi Minh * T?p 20 * So 4 * 2016 Nghien cim Y hpc
+ Dang CO nghe nghiep co ban hay huong den trong tuong lai,
+ Tao dieu kien cho nguoi benh co viec lam on dinh.
+ Co nguon kinh phi ho tro.
+ Co su huan luyen ve cham soc siic khoe va theo doi dien tien de phat hien som cac bieh chiing sau ghep.
+ Co ki&i thiic toi thieu de co the hieu va tuan thii tot qui dinh dieu tri sau ghep.
- Ngoai ra, tot nhat can phai eo mpt quy tai chinh ciia Nha nuoc va cac nha tai trp danh ho trp rieng cho ghep tang.
Tai Uc (2007-2008)P>, uoc tinh ehi phi dieu tri cho BN Ipc than 6 benh vien trung tam la 76.900 dola/nam. Tai cac berth vien ngoai 6 khoang 63.500 dola/nam, va dieu hi tai nha la 47.800 dola/nam, TPPM la 51.600 doia/nam. Ghep than thi cai thien dupe ti le hi vong ve lau dai, nang cao chat lupng cupc song va ehi phi eho dieu tri ciing thap bon. Vi toan bp chi phi dieu tri la do Nha nuoc chi tra, nen hp luon tim phuong phap dieu tri nao co chi phi thap nhat de ap diing. Do do, than nhan tao va tham phan phiic mae chi la phuong phap dieu tri tam thoi trong khi cho ghep than, va tap trung eao dp vao vi^c lim hieu, tuyen truyen, van dpng cong dong tinh nguyen irden tang ctiu nguoi khi chang may qua doi.
Tom lai, qua 3 tru'ong hc^p ghep than cho nguoi ngheo t?i BVCR, ket hpp voi kinh nghiem nghien cuu ciia cac nuoc tren the gioi, so khoi chiing ta da thay Viet Nam cung co the to chiic thuc hien dupe ghep than eho nguoi ngheo (do CO rat nhieu nha hao tam hoat dpng tu thien, nhung do chi la nhiing boat dpng rieng le mang tinh tu phat). Can phai c6 chinh sach ho trp co ban tir quy BHYT, tu Bp tai chinh, Thuong binh xa hpi va co mpt to chiic chuyen trach ciia Quoc gia diing ra lap quy tu thien va keu gpi su chung tay dong gop eiia toan xa hpi.
TAI UtV THAM KHAO
1 Arogundade FA (2013), "Kidney transplantation in a low- resource setting Nigena expenence". Kidney Intemationai Supplements, 3,241-245
2 Australian Institute of Health and Welfare (2012), "Dialysis and kidney transplantation in Australia; 1991-2010", Cat. no.
PHE 162. Canberra: AIHW.
3 Paul MJ, Frank Th De Charro, Elizabeth AT, Les LN, Samir K,B. va Miguel C R . {2Q08), "Reimbursement and Economic Factors Influendng Dialysis Modality Choise Around die world", Nephrol Dial Transplant 23:2365-2373.
4 Syed AHR, Syed AAN, Mirza NZ; va Syed FA (2013), "A kidney transplantation model in a low-resource country: an experience from Pakistan", Kidney International Supplements, 3,236-240
5 Vivekanand Jha (2013), "Current status of end-stage renal disease care in India and Pakistan", Kidney International Supplements 3,157-160.
Ngdy nhan bdi bdo. 10/11/2015 Ngdy phdn biSn nhqn xet bdi bdo: 25/11/2015 Ngdy bdi bdo duac ddng-15/05/2016
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