心理干预对广州市流动人口涂阳肺结核患者治疗依从性的影响

目的 探讨心理干预对广州市流动人口涂阳肺结核患者治疗依从性的影响。 方法 采用症状自评量表(SCL-90)和社会支持评定量表（SSRS），对2008年9月2日至2010年4月30日期间确诊并接受治疗及管理的640例广州市流动人口初治涂阳肺结核患者进行心理测评，将其中存在心理障碍的患者164例采用抽签法分为对照组和干预组,每组各82例。两组均给予2H₃R₃Z₃E₃/4H₃R₃方案治疗，干预组同时增加以支持疗法为主的心理干预措施，对干预后两组的心理测评和第2个月末服药依从率结果进行统计学分析，计量资料数据采用t检验，计数资料数据采用χ²检验，以P<0.05为差异有统计学意义。观察两组患者对治疗的依从性。 结果164例入选患者心理障碍主要表现在躯体化、焦虑、强迫、抑郁等4个因子。心理干预后，对照组躯体化、焦虑、强迫、抑郁等4个因子得分分别为1.51±0.53、1.50±0.46、1.75±0.54、1.65±0.61，干预组的结果分别为1.25±0.49、1.27±0.44、1.50±0.50、1.36±0.60，明显低于国内常模数据(1.37±0.48、1.39±0.43、1.62±0.52、1.50±0.59)，差异均有统计学意义（t=2.21、2.46、2.17、2.11，P值均<0.05）；与对照组比较，干预组得分也明显较低，差异均有统计学意义（t=3.27、3.28、3.08、3.09，P值均<0.01）。同时，干预组的社会支持度得分（22.67±5.51、8.75±3.15、7.98±2.19、37.23±6.67）则高于对照组得分（20.56±4.43、6.93±2.21、7.01±2.42、33.87±5.43），差异有统计学意义 (t=2.70、4.28、2.69、3.53，P值均<0.01)。第2个月末干预组服药依从率（96.3%，79/82）也显著高于对照组（82.9%，68/82），差异有统计学意义(χ²=7.94，P<0.01)。 结论 对广州市流动人口肺结核患者采取心理干预措施可有效提高治疗依从性。

Psychological treatment and the effect on patients' adherence of smear positive TB patients in floating population in Guangzhou

Objective To explore the effect of psychological treatment for the smear positive TB patients in floating population in Guangzhou and its effect on patients＇ treatment adherence. Methods Psychological states of the 640 new smear positive TB patients who were diagnosed and initiated treatment from September 2, 2008 to April 30, 2010 were evaluated by Symptom Checklist 90 （SCL-90） and Social Support Rating Scale （SSRS）. One hundred and sixty-four cases with psychological obstacles were randomly divided into control group and intervention group with 82 cases each. 2HaRaZ3 E3/4H3R3 was applied to both groups while comprehensive psychological intervention （mainly supporting treatment） was applied to the intervention group. The differences of psychological states and treatment compliance rates at the end of the second month between the two groups were compared, t test （measure- ment data） and x2 test （count data） were applied and the level of significance was set to P〈0.05. Results The psychological obstacles of the 164 patients were mainly reflected in four factors （somatization, anxiety,obsession and depression）. After intervention the scores of the factors in control group were 1.51±0. 53, 1.50±0.46, 1.75±0.54 and 1.65±0.61 respectively. While those of the intervention group were 1.25±0.49, 1.27±0.44, 1.50±0. 50 and 1.36±0. 60, which were significantly lower than the domestic norms （1.37±0. 48,1.39±0. 43,1.62± 0. 52,1. 50±0. 59） （t=2.21, 2.46, 2.17 and 2.11, P〈0.05） and the control group（t=3.27, 3.28, 3.08 and 3.09,P〈0. 01）. The scores of SSRS in the interventions （22.67±5.51, 8.75±3.15, 7.98±2.19 and 37.23±6.67） were higher than those in the controls （20. 56±4.43, 6.93±4. 43, 7. 01±4. 42 and 33.87±5.43）, and the differences had statistical significance （t= 2.70, 4.28, 2.69 and 3.53,P〈0.01）. The treatment compliance rate in the intervention group at the end of the second month＇s treatment （96.3%, 79/82） was significantly higher than that in the control group （82.9%,68/82）（X2 =7.94, P〈10. 01）. Conclusion Psychological intervention in floating TB patients can effectively improve their treatment adherence.