酒精依赖患者脑卒中后戒酒依从性影响因素分析

Influential factors for abstinence adherence in patients with alcohol dependence after stroke

目的探讨及分析酒精依赖患者脑卒中后戒酒依从性的相关影响因素。方法对常德地区多中心卒中登记数据库中的134例酒精依赖患者在脑卒中1年后饮酒情况进行调查,根据受教育程度、脑卒中部位等进行分组,用SPSS20.0软件包进行数据统计分析其相关影响因素。结果在134例患者中戒酒率为56.7%;复饮组的离婚、丧偶或再婚率高于未复饮组(18/40∶9/67,χ2=7.531,P=0.006),居住地在农村的比例大于未复饮组(33/25∶7/49,χ2=6.067,P=0.014);每日饮酒量高于未复饮组[(510±187)ml∶(392±101)ml,t=3.93,P=0.000];HRSD-24评分均高于未复饮组[(19±6.1)ml∶(10±7.3)ml,t=4.37,P=0.000];小学及以下组戒酒率为46.2%,中学组为63.4%,大专及以上组为73.1%(χ2=6.563,P=0.038);Logistic回归分析显示受教育程度低、卒中后抑郁情绪、额叶卒中为酒精依赖患者脑卒中后戒酒依从性的危险因素,OR值分别为1.292、7.217和2.282。结论不良的婚姻、居住在农村、每日饮酒量高、较低的受教育程度、伴有抑郁情绪及额叶卒中的患者戒酒依从性差,医务人员应加强心理疏导及健康指导,家属应对出院后饮酒方面进行控制。

Objective To investigate the influential factors for abstinence adherence in patients with alcohol dependence after stroke. Methods A total of 134 patients with alcohol dependence were selected from the muhi-center stroke registry database in Changde, China to investigate their alcohol uses one year after stroke. These patients were grouped according to educational level, location of stroke lesion, and so on. Statistical analysis of data was performed using SPSS 20.0 to determine the influential factors for abstinence adherence. Results Of all patients, 56.7% abstained from drinking. Compared with the abstinence group, the relapse group had a significantly higher proportion of individuals who divorced, were bereft of their spouses, or remarried （ 18/40 vs 9/67 ,Х^2 = 7. 531, P = 0.006 ）, a significantly higher proportion of individuals who lived in rural areas （33/25 vs 7/49, Х^2 = 6. 067, P = 0.014 ）, significant- ly higher daily alcohol consumption （510 ±187 ml vs 392 ±101 ml,t =3.93 ,P =0.000）, and a significantly higher HRSD-24 score （ 19 ±6.1 ml vs 10 ±7.3 ml,t =4. 37 ,P =0.000）. The abstinence rates for patients with educational levels of primary school and be- low, secondary school, and college and above were 46.2% , 63.4% , and 73.1% , respectively, with a significant difference between the three groups （Х^2 = 6. 563,P = 0.038）. The logistic regression analysis showed that less education, depression after stroke, and le- sion in the frontal lobe were adverse factors for abstinence adherence （ OR = 1. 292, 7. 217, and 2. 282, respectively）. Conclusions Poor marriage, living in rural areas, high daily alcohol consumption, low education level, depression after stroke, and frontal lobe stroke are adverse factors for abstinence adherence. Medical workers should strengthen psychological counseling and health guidance, and alcohol consumption should be controlled at home after discharge.