本文選題：美沙酮維持治療 + 試驗性研究�。� 參考：《暨南大學》2013年碩士論文

【摘要】：目的： 1.評價向美沙酮維持治療（MMT）醫(yī)務人員提供推廣合理高劑量相關強化培訓對新入組MMT病人美沙酮劑量水平的影響； 2.評價推廣合理高劑量美沙酮方案對提高MMT病人保持率的干預效果。 方法： 本研究采用試驗性研究的方法。將MMT門診隨機分為干預組和對照組，對干預組MMT診所醫(yī)生實施推行合理高劑量美沙酮處方的相關強化培訓，并評估其對病人在MMT門診的美沙酮治療劑量以及保持情況的效果。2012年2月對選擇的MMT門診醫(yī)生提供相關強化培訓，2012年3月1日至2012年9月1日招募MMT新病人為效果評估研究對象，并對其進行6個月治療情況的跟蹤評估。 回顧性地收集對照組與干預組所在診所2011年9月1日至2012年3月1日，入組的新病例6個月內的治療情況。作為對照組與干預組提供干預前的診所原有的基本情況，分析影響患者每日平均劑量及保持率的因素，同時區(qū)分強化培訓后醫(yī)生干預實施的效果。 結果： 1.非條件logistic回歸模型多因素分析結果顯示，影響美沙酮診所中使用高劑量美沙酮的因素包括：高中、中專及以上文化（OR=1.952，95%CI：1.087，3.503）；吸毒方式（OR=2.425，95%CI：1.388，4.239）；戒毒情況（OR=2.366，95%CI：1.044，5.358）。 2.Cox比例風險回歸模型多因素分析結果顯示，影響美沙酮診所病人脫失的因素包括：年齡段（40~49歲相對18~29歲年齡組RR值為0.510，95%可信區(qū)間為（0.330，0.788），≥50歲年齡組相對18~29歲年齡組的RR值為0.417，95%可信區(qū)間為（0.191，0.913））。 3.試驗性研究對照組202名病人每日平均劑量為55.15±23.15mg/d，干預組315名病人每日平均劑量為58.80±26.01mg/d，差別無統(tǒng)計學意義（P=0.106）； 4.試驗性研究對照組平均保持時間為4.51±0.14月，6個月保持率為57.9%；干預組平均保持時間為4.60±0.09月，6個月保持率為61.0%，對照組與干預組保持率曲線經過log-rank檢驗，差別無統(tǒng)計學意義（χ2=0.409，P=0.522）。 結論： 1.對MMT診所醫(yī)生提供推行合理高劑量相關強化培訓短期內對提高病人美沙酮劑量的效果不佳； 2.干預組MMT診所保持率并不優(yōu)于按常規(guī)治療方案的對照組，對醫(yī)生進行的強化培訓在短時間內沒能產生理想的作用； 3.目前我國的美沙酮維持治療仍處于摸索階。醫(yī)務人員知識背景的差別，及患者對MMT劑量的影響，通過短期培訓MMT醫(yī)生以提升病人保持率還比較困難。
[Abstract]:Objective: 1. Objective: to evaluate the effect of intensive training in the promotion of reasonable high dose related to methadone maintenance therapy (MMT) on the dose level of methadone in new MMT patients. 2. Objective: to evaluate the effect of popularizing reasonable high dose methadone regimen to improve the retention rate of MMT patients. Methods: This study adopts the method of experimental study. MMT outpatients were randomly divided into intervention group and control group. The doctors of MMT clinic in the intervention group were trained to carry out the prescription of reasonable high dose methadone. To evaluate the efficacy of methadone dosage and maintenance of patients in MMT outpatient clinics. Intensive training was provided to selected MMT outpatients in February 2012, and the recruitment of new MMT patients from March 1, 2012 to September 1, 2012 was effective. Fruit evaluation subjects, They were followed up for 6 months. The treatment of the new cases in the control group and the intervention group within 6 months from September 1, 2011 to March 1, 2012 was collected retrospectively. As the control group and the intervention group to provide the original basic situation of the clinic before the intervention, analysis of the impact of the daily average dose and maintenance rate of the factors, at the same time distinguish the effect of doctor intervention after intensive training. Results: 1. The multivariate analysis of non-conditional logistic regression model showed that the factors affecting the use of high dose methadone in methadone clinics included: high school, technical secondary school and above culture: 1. 952CIO: 1.087 / 3.503; drug abuse mode: OR2.425 / 95CIV1.3884.239; Drug abstinence: 2.36695CIW 1.044 / 5.358. The results of multivariate analysis of 2.Cox proportional risk regression model show that, The factors influencing the loss of patients in methadone clinic were as follows: RR of 40 49 years old group was 0. 510 0 95% confidence interval (CI) 0.330 0. 788% confidence interval (CI) was 0. 417 鹵95% confidence interval (r = 0. 191 0. 913 8), and the RR value of 鈮，

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