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[四川地区阿片类物质依赖者立体定向手术治疗的近期疗效及其影响因素研究]

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

作者信息

Zhang Ben, Liao Jing, Wang Zheng-Rong, Chen Yun, Gu Jian-wen, Chen Li-gang, Fang Jun

机构信息

West China School of Public Health, Sichuan University, Chengdu 610041, China.

出版信息

Wei Sheng Yan Jiu. 2006 Sep;35(5):599-603.

Abstract

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.

摘要

目的

探讨四川地区接受立体定向手术治疗阿片类药物依赖患者的一般特征、手术前后复吸原因,评估复吸率及其影响因素和治疗效果。

方法

于2005年3月至6月在四川省采用统一问卷,通过面对面及电话访谈,并结合患者病历资料进行调查。邀请208例患者(共212例患者接受手术)收集其一般特征、吸毒史及手术相关信息。采用t检验、卡方检验及logistic回归等统计方法对数据进行分析。

结果

(1)181例男性患者和27例女性患者参与本研究,平均年龄为(29.5±5.5)岁。大部分受访者来自四川及周边省份,高中及以上学历,职业多样。(2)所有患者术前均滥用阿片类药物,平均吸毒时长为(7.6±3.4)年。所有患者术前均采用自愿或强制戒毒方式脱毒,平均戒毒时长为13.9天,但每次戒毒后均复吸。(3)术前复吸的两大主要原因是无药可用和戒断综合征。与术前复吸相比,术后复吸的两大主要原因是验证手术治疗药物依赖的效果及药物环境的诱惑。(4)并发症发生率为38.0%(79/208),患者未出现严重并发症,且大部分并发症在出院前消失或痊愈。术后7个月内复吸率为22.1%(46/208)。术后复吸患者与术前复吸患者相比,复吸时间、复吸剂量、对毒品的主观感受及复吸欣快感均显著降低。单因素和多因素分析显示,术后复吸率的潜在显著预测因素包括文化程度(OR = 3.259)、手术时间(OR = 2.451)、社会支持(OR = 23.256)及从事简单工作(OR = 3.328)。

结论

本调查表明,立体定向手术可消除大多数患者对毒品的心理渴求及戒断综合征。这些患者术后短期治疗效果满意,复吸率大幅下降,且未出现严重并发症。复吸与患者的文化程度、手术时间、神经心理因素及社会状况密切相关。因此,患者家属及社会应加强对患者的关爱、理解及支持,营造更好的生活和工作环境,以促进患者彻底戒除毒品。平均吸毒时长为(7.6±3.4)年。所有患者术前均采用自愿或强制戒毒方式脱毒,平均戒毒时长为13.9天,但每次戒毒后均复吸。(3)术前复吸的两大主要原因是无药可用和戒断综合征。与术前复吸相比,术后复吸的两大主要原因是验证手术治疗药物依赖的效果及药物环境的诱惑。(4)并发症发生率为38.0%(79/208),患者未出现严重并发症,且大部分并发症在出院前消失或痊愈。术后7个月内复吸率为22.1%(46/208)。术后复吸患者与术前复吸患者相比,复吸时间、复吸剂量、对毒品的主观感受及复吸欣快感均显著降低。单因素和多因素分析显示,术后复吸率的潜在显著预测因素包括文化程度(OR = 3.259)、手术时间(OR = 2.451)、社会支持(OR = 23.256)及从事简单工作(OR = 3.328)。

结论

本调查表明,立体定向手术可消除大多数患者对毒品的心理渴求及戒断综合征。这些患者术后短期治疗效果满意,复吸率大幅下降,且未出现严重并发症。复吸与患者的文化程度、手术时间、神经心理因素及社会状况密切相关。因此,患者家属及社会应加强对患者的关爱、理解及支持,营造更好的生活和工作环境,以促进患者彻底戒除毒品。

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