美沙酮维持治疗社区综合干预的前瞻性研究——120例疗效分析  

Prospective study of integrated community intervention in methadone maintenance treatment

作　　者：薛丽燕 潘启超[2] 张锐敏[3] 朱紫青 庄鸣华[2] 方惠[2] 孙斌[2] 李学海 

机构地区：[1]上海交通大学医学院附属精神卫生中心,上海200030 [2]上海市疾病预防控制中心,上海200336 [3]云南省药物依赖防治研究所,昆明650228

出　　处：《中国药物滥用防治杂志》2011年第3期129-134,140,共7页Chinese Journal of Drug Abuse Prevention and Treatment

基　　金：上海市禁毒基金项目经费(编号200602)资助

摘　　要：目的:观察美沙酮维持治疗疗效,探索社区综合戒毒康复干预模式。方法:选择二家美沙酮维持治疗(MMT)门诊病例120例开展纵向研究。采用MMT常规干预、社会心理干预(各种宣教培训、集体/个体心理辅导和咨询)及社会帮教监管等综合干预方法。于干预前,干预5月、10月后分别评估患者自愿就诊保持率、多项社会心理测试指标(FAD、SSRS、SAS、SDS),并逐月检测尿液吗啡含量,观察综合干预效果。结果:干预后:①自愿就诊保持率提高(58.7%→79.2%,P<0.001)。②社会家庭功能、焦虑情绪获得改善(P<0.001,P<0.001);"社会支持"评分无统计学意义改善(P>0.05);但继发抑郁略加重(均分提高0.03)。③尿检阳性率逐月降低,即尿检阴性率明显提高(59.2%→81.9%,P<0.001)。提示偷吸毒品现象得到有效控制。结论:社会心理综合干预对提高MMT门诊病人的治疗依从性和自愿就诊保持率,帮助病人适应和回归社会将起到积极和重要的作用;建议将综合性社会心理干预作为美沙酮维持治疗的一个重要基础性工作,在有条件的区、县开始施行,从管理要求、队伍建设、人员培训和工作机制等方面不断完善、健全。Objective： To observe the efficacy of methadone maintenance treatment, and explore community comprehensive intervention model for rehabilitation. Methods： To carry out longitudinal study of 120 cases in two methadone maintenance treatment （MMT） clinic by using of MMT intervention, psychosoeial interventions （ a variety of missionary training, group / individual counseling and advice） and social assistance and education supervision and comprehensive intervention. At the beginning, 5 months, and 10 months the patients were assessed by the voluntary retention rate, a number of social and psychological test indicators （FAD, SSRS, SAS, SDS）, and testing the content of urine morphine every month to observe the effect of comprehensive intervention. Results： After the intervention： 1. to maintain a voluntary attendance rate （58. 7%→79. 2%, P 〈0. 001 ） ; 2. social and family functions, anxiety improved （P 〈 0. 001 ,P 〈 0. 001 ） ; ＂social support＂ score was no significant improvement （ P 〉 0. 05 ） ; but secondary depression slightly increased （mean increase 0.03 ） ;3. reduced monthly rate of positive urine test, urine test negative rate that is significantly improved （59.2%→ 81.9%, P 〈0. 001 ）. The phenomenon of drug users stealing tips has been effectively controlled. Conclusions： Psychosocial interventions can improve the MMT comprehensive outpatient treatment compliance and retention of voluntary visits and help patients adapt and return to society, which will play an active and important role;We propose that comprehensive psychosocial intervention should be an important basic work of methadone maintenance treatment; In the districts with conditions, the intervention can be used and improved continuously from the management requirements, team building, personnel training and working mechanism to make it perfect.

关 键 词：阿片类依赖 美沙酮维持治疗 社会心理干预 社区 

分 类 号：R749.64[医药卫生—神经病学与精神病学]