影响美沙酮维持治疗效果的相关因素分析

目的:探讨影响美沙酮维持治疗时间及效果的相关因素。方法:研究对象为329名在我院美沙酮维持门诊治疗的海洛因依赖者。根据其在维持治疗门诊中服药时间的长短分为4组。Ⅰ组为服药时间不足3个月退出治疗者124人;Ⅱ组为服药时间超过3个月但不足6个月治疗者52人;Ⅲ组为服药时间超过6个月,但不足1a治疗者76人;Ⅳ组为服药时间超过1a治疗者77人。比较4组海洛因依赖者间的社会人口学特征、药物依赖及治疗剂量等影响美沙酮维持治疗等因素的差别。结果:Ⅱ组、Ⅲ组、Ⅳ组与Ⅰ组相比较,文化程度、职业、婚姻、社会支持系统差异均有统计学意义(P<0.05或P<0.01);Ⅱ组、Ⅳ组与Ⅰ组、Ⅱ组年龄相比较差异有统计学意义(P<0.01);Ⅱ组、Ⅲ组、Ⅳ组与Ⅰ组比较,初吸年龄、吸毒时间、吸毒频率差异均有统计学意义(P<0.05或P<0.01);吸毒方式(单纯注射)、多药物滥用的Ⅱ组、Ⅲ组、Ⅳ组与Ⅰ组、Ⅱ组比较,有非常显著性差异(P<0.05或P<0.01)。首次吸毒原因各组间无差异(P>0.05),既往脱毒次数Ⅲ组、Ⅳ组与Ⅰ组比较差异均有统计学意义(P<0.01)。服用美沙酮剂量与维持治疗时间呈高度正相关(P<0.01),药物剂量、治疗期间服药不稳定的Ⅰ组与Ⅱ组比较,P<0.05;Ⅰ组与Ⅲ组、Ⅳ组比较,P<0.01,差异均有统计学意义。结论:年轻的单身、无业、文化程度低、无家人支持、多药物滥用和维持剂量不足是影响美沙酮维持治疗依从性的危险因素。临床上对影响维持治疗的危险因素进行甄别,并采取相应的干预措施,能有效提高美沙酮维持治疗效果。

CORRELATION FACTORS INFLUENCING THE EFFECT OF METHADONE MAINTENANCE TREATMENT

Objective:To explore the factors influencing the duration and effect of methadone maintenance treatment(MMT).Methods:A survey was conducted in 329 heroin dependent patients who had done and were doing MMT in our methadone maintenance treatment clinic.The subjects were divided into four groups according to the time that they were on MMT:Group Ⅰon MMT less than 3 months(124 cases);Group Ⅱ 3 months to 6 months(52 cases);Group Ⅲ 6 months to 1 year(76 cases)and Group Ⅳ more than 1 year to analyze the correlated factors influencing the patients on MMT.Results:Comparing Group Ⅱ,Ⅲ and Ⅳ with GroupⅠ,there was statistical significant difference(P<0.05 or P<0.01)in the sense of educational level,career,marriage status,social supporting system;for age,there was significant difference befween Group Ⅲ,Ⅳand Ⅱand Ⅰ(P<0.01);comparing GroupⅠwith Group Ⅱ,Ⅲ and Ⅳ,there was statistical significance(P<0.05 or P<0.01)in the sense of age of initial use,duration and frequency of taking drugs;comparing Group Ⅱ,Ⅲ,Ⅳ with GroupⅠ,there was statistical significance(P<0.05 or P<0.01)in the sense of injecting drugs and multi-drug abuse,but no difference in reasons of initial drug use(P> 0.05).And there were statistical significance in the sense of times of drug detoxification among Group Ⅱ,Ⅲ,Ⅳ and GroupⅠ(P<0.05).There was significant positive correlation between dose of methadone taken and duration of maintenance treatment(for GroupⅠ and GroupⅡ P<0.05,for GroupⅠand Group Ⅲ and Ⅳ P<0.01).Conclusion:Single,young,unemployment,low educational level,no family support and multi-drug abuse and inadequate dose of methadone were risk factors influencing the conduction of MMT and causing relapse.To discriminate the dangerous correlation factors for MMT in clinic,and take appropriate intervention measures can effectively improve the effect of MMT.