四川省成都及乐山地区美沙酮维持治疗门诊病人综合治疗模式研究

COMBINED TREATMENT MODES RESEARCH ON METHADONE MAINTAIN-TREATMENT DROP-OUT OUTPATIENTS FROM SICHUAN CHENGDU AND LESHAN CITY

目的:探讨四川省两个地区美沙酮维持门诊病人脱失相关因素,并采取一系列应对策略,以提高维持率,降低脱失率。方法:使用《海洛因依赖相关危险因素调查表》对200例美沙酮门诊维持治疗病人进行调查,按入组单双号随机分成研究组和对照组,对研究组进行相关危险因素干预,药物维持剂量调整,心理辅导、同伴教育、小组活动、家访等综合治疗,对照组进行单纯美沙酮维持治疗,每两周对两组人员进行一次稽延性戒断症状评价,6个月后比较两组脱失率及保持率。结果:对5次稽延性戒断症状评定分数进行t检验结果显示:研究组在治疗开始后2周、4周、6周、8周的稽延性戒断症状评定分数均较对照组小,差异有统计学意义(P<0.05)。第10周的稽延性戒断症状比较,差异无统计学意义(P=0.072)。6个月后研究组及对照组的脱失率分别为7%和15%,差异有统计学意义(P=0.025)。结论:对美沙酮维持门诊病人预先进行相关危险因素评估,有针对性地进行药物维持和社会心理康复治疗相结合的综合治疗模式能降低脱失率,提高保持率,最终降低艾滋病的发病率。

Objective：To investigate the relative drop-out factors of the methadone outpatients who maintain treatment from two regions in Sichuan Province,and take some series of reply measures to reduce the drop-out ratio. Methods：Use relative risk factors survey tables of heroin dependence to investigate 200 methadone treatment-maintain outpatients,and divide them randomly into research group and control group according to odd and even number,and have intervention to the research group as well as some combined treatment modes：adjustment of medicine dosage-maintain,psychology assistance,company education,group exercise,family visit etc; on the other side,take pure methadone treatment-maintain cure to comparison group,and evaluate the two groups with protracted withdrawal syndrome every two weeks,and compare the drop-out and maintenance ratio of the two groups 6 months later at last. Results：After analysis,the judgment scores of 5 times protracted withdrawal syndrome by using 2 independent samples t-test,we get：the scores of research group after 2,4,6,8 weeks beginning from the cure are smaller than control group,so the difference gets statistical significance （P〈0.05）. Moreover,the difference after 10 weeks is insignificant （P=0.772）. The drop-out ratio 6 months later of research group and control group is 7% and 15%,respectively,so the difference has no statistical significance （P=0.071）. Conclusion：According to the evaluation of previous relative risk factors of methadone treatment-maintain outpatients,we can reduce the drop-out ratio,raise maintenance ratio,thereby reduce incidence of AIDS by using combined treatment modes of medicine maintenance combined with social psychology recovery cure contrapuntally.