本文關(guān)鍵詞：德州市艾滋病患者抗病毒治療現(xiàn)狀與效果研究　出處：《山東大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 艾滋病 抗病毒治療 現(xiàn)況 效果 研究

【摘要】：研究背景艾滋病是由艾滋病毒(HIV)感染引起的傳染病,目前無(wú)有效的疫苗預(yù)防,病死率高,艾滋病的傳播流行嚴(yán)重危害人類(lèi)健康和經(jīng)濟(jì)社會(huì)發(fā)展。艾滋病的防治已成為全球關(guān)注的公共衛(wèi)生和社會(huì)問(wèn)題。高效逆轉(zhuǎn)錄病毒療法(HAART)的廣泛運(yùn)用,使艾滋病從一種致死性疾病轉(zhuǎn)變?yōu)橐环N慢性可控性疾病。HAART可以有效的抑制HIV在人體的復(fù)制,提高人體CD4細(xì)胞水平,恢復(fù)患者免疫功能,延緩病程進(jìn)展,降低病死率。隨著時(shí)間的推移,國(guó)家越來(lái)越重視艾滋病防治工作,國(guó)家免費(fèi)抗病毒治療納入標(biāo)準(zhǔn)多次放寬,致使接受HAART的艾滋病患者急劇增長(zhǎng)。本課題通過(guò)調(diào)查抗病毒治療工作現(xiàn)況,評(píng)價(jià)治療效果,分析影響因素,為研究防治對(duì)策,采取更有針對(duì)性、科學(xué)性、規(guī)范性的抗病毒治療措施提供科學(xué)依據(jù)。研究目的調(diào)查德州市艾滋病患者抗病毒治療現(xiàn)況,評(píng)價(jià)艾滋病抗病毒治療效果,分析影響因素,研究防治對(duì)策,為今后的艾滋病抗病毒治療工作提供科學(xué)依據(jù)和借鑒。研究對(duì)象與方法采用方便抽樣,對(duì)德州市目前接受抗病毒治療的艾滋病患者開(kāi)展問(wèn)卷調(diào)查,了解艾滋病抗病毒治療現(xiàn)況。采用回顧性調(diào)查,收集德州市首次接受HAART的艾滋病患者的抗病毒治療相關(guān)數(shù)據(jù),包括人口學(xué)特征、基線(xiàn)調(diào)查數(shù)據(jù)、歷次隨訪狀況、當(dāng)前轉(zhuǎn)歸等。對(duì)收集的治療數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析,了解免疫重建效果、HIV抑制、生存時(shí)間等情況,對(duì)抗病毒治療效果進(jìn)行綜合評(píng)價(jià)。將現(xiàn)場(chǎng)問(wèn)卷調(diào)查資料使用EPIDATA3.1軟件錄入,收集到的艾滋病抗病毒治療數(shù)據(jù)以Excel軟件建立調(diào)查數(shù)據(jù)庫(kù),整理后使用SPSS 19.0軟件進(jìn)行統(tǒng)計(jì)分析。計(jì)數(shù)資料比較采用x2檢驗(yàn)。均數(shù)比較采用T檢驗(yàn)、單因素方差分析等。Logistic回歸分析篩選影響患者依從性、抗病毒治療機(jī)構(gòu)選擇意愿及免疫功能重建的因素。單因素方差分析及多因素Cox比例風(fēng)險(xiǎn)回歸模型用于生存率的比較。研究結(jié)果1.本次研究,抗病毒治療現(xiàn)況調(diào)查共發(fā)放問(wèn)卷273份,收集有效問(wèn)卷264份(96.73%);抗病毒治療效果評(píng)價(jià)納入調(diào)查對(duì)象306例。2.艾滋病抗病毒治療現(xiàn)況調(diào)查:德州市采取的是疾控機(jī)構(gòu)為責(zé)任主體的抗病毒治療工作模式;研究對(duì)象艾滋病防治基礎(chǔ)知識(shí)知曉率為97.35%(257/264),艾滋病相關(guān)知識(shí)知曉率為65.53%(173/264),結(jié)果顯示性別、婚姻狀況、職業(yè)及社會(huì)組織關(guān)懷等為艾滋病相關(guān)知識(shí)知曉程度的影響因素;有228例(86.36%)患者認(rèn)為治療效果很好,95.45%(252/264)的患者自評(píng)能夠配合抗病毒治療;94.32%(249/264)的患者自評(píng)能夠堅(jiān)持今后的抗病毒治療;研究對(duì)象藥物有效依從性的比例為96.97%(256/264),分析顯示"治療效果自評(píng)"為影響患者漏服行為的因素;81.44%(215/264)的艾滋病患者希望今后由疾控機(jī)構(gòu)負(fù)責(zé)艾滋病抗病毒治療,18.56%(49/264)選擇了醫(yī)療機(jī)構(gòu)。3.艾滋病抗病毒治療效果評(píng)價(jià):研究對(duì)象初始治療采用一線(xiàn)方案的占91.50%(280/306);有80例(26.14%)患者接受復(fù)方新諾明預(yù)防及治療機(jī)會(huì)性感染;72例(23.53%)發(fā)生了藥物毒副反應(yīng);52例(16.99%)更換了藥物,換藥原因包括一線(xiàn)藥物治療失敗、毒副作用等;11例接受HAART的患者退出了治療序列,退出原因主要包括藥物毒副作用、失訪、藥物相互作用等;最近一次檢測(cè)結(jié)果顯示211例(68.95%)患者獲得了良好的免疫重建效果或維持,Logistic分析顯示,治療時(shí)長(zhǎng)、乙肝感染、基線(xiàn)CD4細(xì)胞計(jì)數(shù)等為免疫重建效果的影響因素;治療12個(gè)月HIV完全抑制率為90.19%(193/214),病毒耐藥率為6.16%(13/211);調(diào)查對(duì)象接受HAART后1、3、12、18個(gè)月的生存率分別為97.02%、96.01%、94.86%、93.63%,5年生存率為91.73%,50歲以上人群累計(jì)生存率為76.60%,接受抗病毒治療3年的生存率分別為86.67%、82.98%、76.60%,低于其他人群。多因素Cox分析顯示治療時(shí)年齡及基線(xiàn)CD4細(xì)胞計(jì)數(shù)是患者生存時(shí)間的影響因素。結(jié)論1.德州市艾滋病抗病毒治療效果顯著。通過(guò)HAART有效恢復(fù)了患者的機(jī)體免疫機(jī)能,抑制了病毒復(fù)制,改善了艾滋病患者生活質(zhì)量和生存狀況,延長(zhǎng)了患者生命,多數(shù)患者能夠自覺(jué)積極配合抗病毒治療工作,服藥依從性良好,并給予抗病毒治療工作及其效果正確、公正評(píng)價(jià)。2.德州市以疾控機(jī)構(gòu)為責(zé)任主體的抗病毒治療模式,已經(jīng)不能滿(mǎn)足當(dāng)前艾滋病抗病毒治療需求,疾控機(jī)構(gòu)由于不具備醫(yī)療資質(zhì)及缺乏系統(tǒng)、全面的艾滋病抗病毒治療培訓(xùn)的從業(yè)人員,無(wú)法有效處理患者嚴(yán)重機(jī)會(huì)性感染、藥物毒副作用等,無(wú)法對(duì)患者病情做出全面評(píng)估,存在嚴(yán)重的醫(yī)療風(fēng)險(xiǎn)和責(zé)任風(fēng)險(xiǎn)。同時(shí),部分患者免疫功能重建情況不理想,基線(xiàn)CD4細(xì)胞計(jì)數(shù)低值人群、老年患者需要更多的關(guān)注,部分患者對(duì)現(xiàn)行抗病毒治療工作存在抵觸心理及惰性心理,治療效果自我評(píng)價(jià)不高,服藥依從性較差。3.現(xiàn)行抗病毒治療工作模式亟待轉(zhuǎn)變,將抗病毒治療職責(zé)向醫(yī)療機(jī)構(gòu)移交,提高疾病早期發(fā)現(xiàn)能力,遵循"知情同意"的抗病毒治療原則,滿(mǎn)足患者"專(zhuān)業(yè)"、"保密"、"方便"等抗病毒治療需求,并注重優(yōu)化資源,簡(jiǎn)化流程,加強(qiáng)服藥依從性教育,充分發(fā)揮社會(huì)組織作用,發(fā)掘患者主觀能動(dòng)性,同時(shí)注意保護(hù)患者隱私,關(guān)注患者心理變化,提供更加優(yōu)質(zhì)的專(zhuān)業(yè)醫(yī)療服務(wù)。
[Abstract]:The research background is by HIV AIDS (HIV) infection caused by infectious diseases, currently no effective vaccines to prevent AIDS, high mortality, the spread of serious harm to human health and economic and social development. The prevention and control of AIDS has become a global concern for public health and social problems. Effective antiretroviral therapy (HAART) is widely used so, AIDS from a fatal disease into a chronic disease control.HAART can effectively inhibit the replication of HIV in human body, improve the level of CD4 cells, restore immune function, delay the course of disease progression and reduce mortality. As time goes on, more and more attention to the prevention and treatment of AIDS, the national free antiretroviral the treatment included many AIDS patients to relax, resulting in the rapid growth of HAART. This paper investigated the current status of antiviral therapy, therapeutic effect evaluation, divided Analysis of influencing factors for prevention strategies, more targeted, scientific, and provide scientific basis for antiviral treatment measures normative. Investigation on the status of Dezhou City AIDS antiviral treatment of AIDS antiviral treatment, evaluation results, analyze the influencing factors, research on prevention measures, provide scientific basis and reference for the future work of AIDS antiviral treatment research object and method. By convenient sampling, to carry out the survey in Dezhou city currently receiving antiretroviral treatment of AIDS patients, to understand the AIDS antiviral treatment status. By retrospective investigation, collection of Dezhou city for the first time to accept the HAART AIDS antiviral treatment related data, including demographic characteristics, baseline survey data, the current status of previous follow-up, prognosis the treatment. The collected data for statistical analysis, to understand the immune reconstitution effect, HIV inhibition, survival Time, comprehensive evaluation of antiviral treatment. The field survey data using EPIDATA3.1 software, antivirus treatment of AIDS data collected by the Excel software to establish the survey database, after finishing using the SPSS 19 software was used for statistical analysis. Count data were compared by x2 test. Were compared by T test, single factor analysis of variance.Logistic regression analysis screening effect of patient compliance, intention and selection factors of immune reconstitution of antiviral therapy. Univariate analysis and multivariate Cox proportional hazard regression model was used to compare the survival rate of 1.. The results of this study, antiviral therapy in a total of 273 questionnaires, 264 valid questionnaires were collected (96.73%); evaluation of antiviral treatment included in the survey,.2. survey of AIDS antiviral treatment of 306 cases of status: Dezhou city is taken. The main responsibility for antiviral treatment work mode control mechanism; study of AIDS prevention knowledge awareness rate was 97.35% (257/264), AIDS related knowledge awareness rate was 65.53% (173/264), the results show that the gender, marital status, occupation and social organization care and other factors affecting the degree of awareness of AIDS related knowledge; 228 cases (86.36%) patients that the treatment effect is very good, 95.45% (252/264) patients with self rating with antiviral therapy; 94.32% (249/264) patients with self rating to adhere to the antiviral treatment in the future; the object of study drug compliance ratio was 96.97% (256/264), "the analysis showed that the treatment effect of self rating" for the factors affecting the service behavior leakage patients; 81.44% (215/264) of AIDS patients hope by the disease control agency in charge of AIDS antiviral treatment, 18.56% (49/264) chose.3. antiretroviral therapy in medical institutions Evaluation: the object of study initiated treatment with first-line accounted for 91.50% (280/306); 80 cases (26.14%) patients received cotrimoxazole prophylaxis and treatment of opportunistic infections; 72 cases (23.53%) had adverse drug reactions; 52 cases (16.99%) of replacement drugs, including first-line treatment failure reasons of dressing, poison side effects; 11 cases of HAART patients withdrew from the treatment sequence, exit reasons mainly include side effects, drug lost, drug interactions; a recent test results showed that 211 cases (68.95%) patients achieved good immune effect of reconstruction or maintain, Logistic analysis shows that the duration of treatment, hepatitis B the infection factors, baseline CD4 cell count for immune reconstruction effect; for 12 months HIV completely inhibited the rate of 90.19% (193/214), virus resistant rate was 6.16% (13/211); the survey by HAART after 1,3,12,18 months survival rates were 97.02%, 96.01%, 94.86%, 93.63%, 5 year survival rate was 91.73%, 50 people over the age of the cumulative survival rate was 76.60%, the survival rate of receiving antiretroviral treatment for 3 years were 86.67%, 82.98%, 76.60%, lower than the other groups. Cox regression analysis showed that the treatment of age and baseline CD4 cell count are the factors influencing the survival time of patients. The conclusion of the 1. Dezhou City AIDS antiviral treatment effect. Through the HAART effective recovery of the immune function of patients, inhibit viral replication, improve the quality of life and survival status of AIDS patients, prolong the life of patients, most patients can consciously actively cooperate with the anti viral treatment, good compliance, and given anti viral treatment and its effect correct and fair evaluation.2. in Dezhou City CDC antiviral treatment mechanism is the main responsibility mode, has been unable to meet the current needs of AIDS antiviral treatment, disease control machine Structure because they do not have medical qualifications and the lack of systematic, comprehensive training of AIDS antiviral therapy practitioners, not effective treatment in patients with severe opportunistic infections, drug toxicity, unable to make a comprehensive assessment of the patient's condition, there is a serious health risk and liability risk. At the same time, part of the immune function of patients with reconstruction of the situation is not ideal, baseline CD4 cell count low value population, elderly patients need more attention, some patients have psychological conflict and psychological inertia of current antiviral therapy, the treatment effect of self evaluation is not high, poor compliance.3. current antiviral therapy work mode should be changed, the antiviral treatment of transfer of responsibility to medical institutions, improve the ability to find the disease early, follow the "antiviral treatment of informed consent" principle, to meet with the "professional", "confidential", "demand for convenient treatment and antiviral, and focus on the advantages of Resources should be simplified, processes should be streamlined, medication adherence education should be strengthened, the role of social organizations should be brought into full play, and patients' subjective initiative could be explored. At the same time, attention should be paid to protecting patients' privacy, paying attention to psychological changes of patients, and providing more high-quality professional medical services.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R512.91

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