四川地区立体定向手术治疗阿片类药物依赖的短期效果及其影响因素研究

目的调查四川地区立体定向手术戒除阿片类药物依赖(以下简称手术戒毒)患者的一般特征,患者术前术后复吸的原因,手术的短期戒毒效果及其影响因素。方法使用统一的问卷,采用面谈、电话访问的方法调查了208名(共228名患者参加手术)患者,并且查阅患者的病案。采用t检验、χ2检验以及logistic回归等统计方法分析数据。结果(1)患者男181人,女27人,平均年龄(29·5±5·5)岁,高中以上文化者居多,主要来自四川及周边省区,职业多样。(2)患者均有吸食阿片类毒品的历史,平均吸毒时间(7·6±3·4)年。患者均有自愿戒毒或强制戒毒史,平均戒毒(13·9±5·2)次,每次戒毒后均有复吸。(3)患者术前复吸的主要原因为不吸毒无法忍受和无法忍受戒断症状,而术后复吸的主要原因为想通过吸最后一口来证明疗效和吸毒环境的诱发。(4)手术并发症发生率为38·0%(79/208),多为一过性,在出院前消失或治愈。术后82·7%的患者无吸毒的欲望,84·6%的患者无戒断症状。手术后7个月患者的复吸率为22·1%(46/208),复吸患者的复吸次数、复吸量、对毒品的主观感觉以及复吸的欣快感较术前均有明显的降低。经单因素和多因素回归分析,文化背景(OR=3·259)、手术时间(OR=2·451)、社会支持(OR=23·256)及患者能否从事以前的工作或生活(OR=3·328),为患者发生复吸的最可能的影响因素。结论手术戒毒去除了大部分患者的对毒品的心理渴求及戒断症状。患者的复吸率有很大降低,无严重特异性手术并发症,短期疗效比较满意。发生复吸可能与患者的文化背景、手术时间、精神心理因素以及所处社会环境等有关,因此家庭和社会应加强对其的关心、理解和支持,给他们创造良好的生活、工作环境,以有利于他们彻底戒毒。

Study on short-term therapeutic effect and its impact factors of stereotactic surgery for treating opiate users with opiate dependence in Sichuan

OBJECTIVE: To investigate the common characteristics of the patients, relapse reasons of patients before and after surgery, evaluate the relapse rate and its impact factors, and therapeutic effect of patients accepted stereotactic surgery to treat opiate dependence in Sichuan. METHODS: An investigation, using uniform questionnaires by face-to-face and telephone interview, and gaining data from medical records of patients, was conducted in Mar to Jun 2005, in Sichuan Province. 208 patients (total 212 patients participated in surgery) were invited to gather information about their common characteristics, drug-taking history and the surgery. Statistical methods including t-test, chi2 test and logistic regression were used to analyze the data. RESULTS: (1) 181 male patients and 27 female patients participated in this study, and their mean age was (29.5 +/- 5.5) years. Most of the respondents were in Sichuan and some peripheral province, graduated from senior high school and over, and with various occupations. (2) All patients abused opiate before the surgery, and the average duration of drug-taking was (7.6 +/- 3.4) years. All patients were detoxified by unconstraint or compulsory abstinence before surgery, with mean drug abstinence of 13.9, but relapse occurred after each detoxification. (3) Suffering with no drugs and abstinence syndrome were the two main reasons of relapse before surgery. Compared with relapse before surgery, validating the effect of the surgery treating drug dependence and temptation by drug surroundings were the two main reasons of relapse after surgery. (4) The complication rate was 38.0% (79/208), no severe complications occurred in patients, and most of the complications disappeared or were healed before they were discharged from hospital. Relapse rate within 7 months after surgery was 22.1% (46/208). A significant decrease of relapse time, relapse dose, subjective feel on drugs and relapse euphoria appeared in patients who relapsed after surgery when compared with those before surgery. The univariate and multivariate analysis shows potential significant predictors of relapse rate after surgery to include education (OR = 3.259), operative time (OR = 2.451), social support (OR = 23.256) and doing simple work (OR = 3.328). CONCLUSION: This investigation showed that the stereotactic surgery can eliminate psychological desire for drugs and abstinence syndrome among most of the patients. Satisfactorily short-term therapeutic effect and substantial decline in relapse rate as well as no severe complications were appeared in these patients. Relapse was greatly associated with education, operative time, neuropsychological factors, and social conditions of patients. Therefore, patients' family and the society should strengthen their care, comprehension as well as support, and create better living and working surroundings to facilitate the complete drug abstinence to occur in patients. average duration of drug-taking was (7.6 +/- 3.4) years. All patients were detoxified by unconstraint or compulsory abstinence before surgery, with mean drug abstinence of 13.9, but relapse occurred after each detoxification. (3) Suffering with no drugs and abstinence syndrome were the two main reasons of relapse before surgery. Compared with relapse before surgery, validating the effect of the surgery treating drug dependence and temptation by drug surroundings were the two main reasons of relapse after surgery. (4) The complication rate was 38.0% (79/208), no severe complications occurred in patients, and most of the complications disappeared or were healed before they were discharged from hospital. Relapse rate within 7 months after surgery was 22.1% (46/208). A significant decrease of relapse time, relapse dose, subjective feel on drugs and relapse euphoria appeared in patients who relapsed after surgery when compared with those before surgery. The univariate and multivariate analysis shows potential significant predictors of relapse rate after surgery to include education (OR = 3.259), operative time (OR = 2.451), social support (OR = 23.256) and doing simple work (OR = 3.328). CONCLUSION: This investigation showed that the stereotactic surgery can eliminate psychological desire for drugs and abstinence syndrome among most of the patients. Satisfactorily short-term therapeutic effect and substantial decline in relapse rate as well as no severe complications were appeared in these patients. Relapse was greatly associated with education, operative time, neuropsycological factors, and social conditions of patients. Therefore, patients' family and the society should strengthen their care, comprehension as well as support, and create better living and working surroundings to facilitate the complete drug abstinence to occur in patients.