应用简明健康测量量表评估美沙酮维持治疗患者生活质量

Evaluation of quality of life of patients receiving methadone maintenance treatment by medical outcomes study 36-item short-form health survey scale

目的:对比接受与未接近美沙酮维持治疗的海洛因依赖者健康相关生活质量。方法:①选择2004-04/05在云南省个旧市美沙酮维持治疗门诊接受美沙酮维持治疗的海洛因依赖者作为治疗组(95例)。纳入标准:符合美国精神障碍诊断与统计手册第4版中海洛因依赖诊断标准;至2004-11时尚未脱失;采用滚雪球方法,于2004-11在该市社区内寻找从未接受过美沙酮维持治疗的海洛因依赖者作为对照组(37例),均符合美国精神障碍诊断与统计手册第4版中海洛因依赖诊断标准。纳入对象均对调查项目知情同意。②根据患者的日常海洛因使用量、使用方式、末次使用量决定美沙酮首次剂量,一般<40mg;导入期则根据患者的戒断症状控制情况逐渐加量。维持期的剂量差异较大,5～160mg/d,多超过60mg/d。同时根据治疗组患者的需求,每月定期开展心理干预小组活动。对照组患者未接受美沙酮维持治疗或任何戒毒措施、干预活动,评估期间时仍然在使用海洛因。③治疗组于治疗刚开始及治疗8个月后,对照组于治疗组治疗8个月后同期采用简明健康测量量表对两组对象进行健康相关生活质量评估。该量表包括躯体功能、躯体角色、肌体疼痛、总健康状况、生命力、社会功能、情绪角色及心理健康8个维度,评分越高表明生活质量越好。④计量和计数资料差异比较分别采用t检验和χ2检验。结果:治疗组95例和对照组37例均进入结果分析。参加美沙酮维持治疗8个月后,治疗组简明健康测量量表中6个维度躯体角色、总健康状况、生命力、社会功能、情绪角色及心理健康的评分分别为(6.59±1.48),(15.54±3.97),(16.20±3.91),(8.39±2.29),(4.72±1.17),(20.19±2.68)分,高于治疗刚开始时和对照组[(5.54±1.51),(13.37±3.58),(13.19±3.81),(7.17±2.21),(3.94±1.11),(17.05±4.24)分;(5.43±1.29),(11.83±3.84),(12.89±3.79),(6.71±2.12),(4.06±1.08),(15.77±4.45)分,t=3.02～7.03,P<0.01];躯体功能得分也较治疗前有了明显提高[(27.16±3.24),(26.48±3.34)分,t=1.96,P<0.05],但与对照组比较,差异不明显[(26.31±2.78)分,P>0.05]。治疗组肌体疼痛评分与治疗刚开始时和对照组相近(P>0.05)。结论:美沙酮维持治疗可有效提高海洛因依赖者的健康相关生活质量,但短期的维持治疗对肌体疼痛改善不明显。

AIM： To compare the health-related life quality in heroin clients receiving or non-receiving methadone maintenance treatment. METHODS： （1）Totally 95 cases of heroin dependence patients （treatment group）, who received methadone maintenance treatment at the methadone maintenance treatment clinic of Gejiu City of Yunnan Province, were enrolled from April to May 2004. Inclusive criteria： the patients were diagnosed according to heroin dependence standards of diagnostic ＆ statistical manual （DSM） of American Mental Disorder-Ⅳ, and patients who were not dropped out until November 2004. Cases of control group were 37 heroin addicts diagnosed by DSM-Ⅳ, who were found from the community of Gejiu and not received methadone maintenance treatment by means of roll-snowball in November 2004. The subjects all knew the investigation and agreed. （2）The first dose of methadone, which was determined by daily amount of heroin, method of administration and last dose of heroin, was not greater than 40 mg. It was necessary to increase the doses to control abstinent symptom in the introduction phase. Maintenance doses, which were different from 5 mg per day to 160 mg per day, were mostly greater than 60 mg per day. Monthly group activities of psychological interventions were implemented regularly according to the requirement of patients in the treatment group. Oppositely, control group did not accept any treatment or intervention including methadone maintenance treatment, and were using heroin in the evaluation phase. Investigations of life quality were conducted in the treatment group at the beginning of treatment and 8 months after treatment and in the control group 8 months after treatment by medical outcomes study 36-item short-form health survey scale （MOS SF-36） scale. The SF-36 included eight dimensions that were Physical function, Role-Emotional, Body pain, General Health, Vitality, Social Functioning, Role-Emotional and Mental Health. The higher score represented a better life quality. （4）The difference between measurement data and enumeration data were compared by t test and χ^2 test, respectively. RESULTS： All patients entered the analysis of results with 95 cases in the treatment group and 37 cases in the control group. Eight months after methadone maintenance treatment, the scores of Role-Physical, General Health, Vitality, Social Functioning, Role-Emotional and Mental Health of SF-36 scale were （6.59±1.48）, （15.54±3.97）, （16.20±3.91）, （8.39±2.29）,（4.72±1.17）, （20.19±2.68） points, respectively, which were higher than those at the beginning of treatment and the control group [（5.54±1.51）,（13.37±3.58）,（13.19±3.81）,（7.17±2.21）,（3.94±1.11）,（17.05±4.24） points;（5.43±1.29）, （11.83±3.84）, （12.89±3.79）, （6.71±2.12）, （4.06±1.08）, （15.77±4.45） points, t =3.02-7.03,P 〈 0.01]. Score of Physical function was significantly improved as compared with before receiving methadone maintenance treatment [（27.16±3.24）, （26.48±3.34） points,t =1.96,P 〈 0.05], but the difference between treatment group and control group was not significant [（26.31±2.78） points,P 〉 0.05]. The score of body pain in the treatment group was similar to that in the beginning of treatment and control group （P 〉 0.05）. CONCLUSION： Methadone. maintenance treatment can improve the health-related life quality of heroin clients effectively. But a short-term maintenance treatment seems to have little improvement of body pain.