美沙酮维持治疗中脱失后重入组患者与长期维持治疗患者情况对照分析

COMPARISON STUDY ON RE-ENROLLED PATIENTS AND PATIENTS WITH LONG-TERM METHADONE MAINTENANCE TREATMENT

目的:通过对美沙酮维持治疗中脱失后重入组患者与长期维持治疗患者情况进行对照分析,探讨影响长期维持治疗的相关因素,以便在日常工作中采取针对性措施,降低脱失率,提高治疗效果。方法:调查对象为广州市荔湾区社区药物维持治疗点截至2011年1月1日时在治的229例美沙酮维持治疗患者,选取在接受治疗期间脱失一次及以上的48名患者作为研究组,连续服药3 a及以上的46名患者作为对照组,对两组患者的一般资料及参加治疗情况进行比较,用单因素分析方法分析可能影响长期维持治疗的因素。结果:治疗前因素中,两组患者的性别、居住情况、文化程度、有无职业及经济来源存在差异,且差异有统计学意义(P1=0.029,P2=0.03,P3=0.006,P4=0.014,P5<0.001);治疗阶段因素中,两组患者在参与服药率、参与尿检率及尿检阳性率上均存在差异,且差异有统计学意义(P1<0.001,P2<0.001,P3=0.021)。结论:男性、独自居住、低文化程度、有职业及固定经济来源可能是影响患者长期治疗的风险因素;参加美沙酮维持治疗后,服药剂量过小、服药、参与尿检率低及尿检阳性率较高亦提示服药人员有较大的脱失可能性。

Objective： To explore the risk factors influencing patients for long-term methadone maintenance treatment（MMT） through a comparative analysis between the re-enrolled patients and patients with long-term MMT,find appropriate measures in clinics＇ daily work to reduce drop-out rate,and improve the therapeutic effect.Methods：Study subjects were 229 opioid-dependent patients who were on MMT during January 1,2011 in the Methadone Maintenance Clinic of Guangzhou Brain Hospital.Among them,48 patients who had ever dropped-out of MMT were selected as study group,while 46 patients who were kept on MMT for more than three years as control group.The baseline data and the compliance of patients to MMT were compared between the two groups,the risk factors influencing patients for long-term maintenance treatment were analyzed by means of univariate analysis.Results：Before MMT,there was statistically significant difference in sex,living conditions,degree of education,employment and sources of income between the two groups（P_1=0.029,P_2=0.03,P_3=0.006,P_4=0.014,P_50.001）;during the treatment,there was statistically significant difference in average daily medication dose,rate of medication taking,urine test participation rate and urine test positive rate between the two groups（P_10.001,P_20.001,P_3=0.021）.Conclusion：Male,living alone,low level of education,being employed and having a fixed source of income may affect the compliance of patients for long-term maintenance treatment.Not enough medication dose,low rate of medication taking and urine test participation rate,relatively high urine test positive rate suggest a greater possibility of dropout.