摘要
目的:评估不同的社区照管模式对痴呆患者生活质量的作用。方法:采用分层多级随机整群抽样方法,于2004-06在广州市进行流行病学调查,按诊断标准确定痴呆患者及轻微认知功能损害患者222例,分为综合干预组(n=16)、心理社会干预组(n=29)和对照组(n=177),心理社会干预组采用心理社会干预,包括对照料者和社区医生进行痴呆卫生宣教,对患者和照料者实施心理社会干预;综合干预组则在心理社会干预的基础上另加药物干预,①改善痴呆症状给予可逆性胆碱酯酶抑制剂石杉碱甲;②非典型抗精神病药物富马酸奎硫平;③抗抑郁药5-羟色胺再摄取抑制剂盐酸氟西汀胶囊。对照组只进行日常看护工作,在干预前、干预后3,6个月,分别采用老年性痴呆生活质量量表评定各组患者的生活质量、日常生活能力量表评定患者的日常生活能力、简明精神病评定量表评定患者的精神症状以及汉密顿抑郁量表评定患者的抑郁情绪。结果:各组患者均完成治疗和测评,全部进入结果分析。①综合干预组干预后生活质量评分较干预前提高,简明精神病评定量表、日常生活能力量表和汉密顿抑郁量表评分较干预前降低;心理社会干预组干预后生活质量评分较干预前提高,日常生活能力量表评分较干预前降低;对照组6个月后生活质量评分较初次评估降低,日常生活能力量表评分较初次评估提高。②综合干预组简明精神病评定量表干预后3个月与干预前评分差值、干预后6个月与干预前评分差值与心理社会干预组、对照组相应评分差值相比,降低更多;综合干预组和心理社会干预组生活质量干预后3个月与干预前评分差值、干预后6个月与干预前评分差值与对照组相应评分差值相比,评分升高更多,日常生活能力量表评分均值降低更多。③干预得分与老年性痴呆生活质量量表差值呈负相关,相关系数为-0.30(P<0.001);与日常生活能力量表差值呈正相关,相关系数为0.27(P<0.001)。结论:在社区支持网络中,药物联合心理社会干预对痴呆患者生活质量的改善效果最佳,单纯心理社会干预的效果次之,对照组呈逐渐恶化趋势。综合干预模式值得推广。
AIM： To evaluate the effect of different community management model on the quality of life （QOL） of patients with dementia in community.
METHODS： By means of stratified random clustering sampling, an epidemiological survey was conducted in Guangzhou city in June 2004 among 222 patients with dementia or mild cognitive impairment identified according to the diagnostic. They were divided into 3 groups： integrated group （n =16, received both psychosocial intervention and drug interventions）, psychosocial interventions group （n =29, received psychosocial intervention alone, including the education about dementia to the corers and community physicians, and the psychosocial intervention to the patients and carers） and control group （n=177, received no special intervention）. The drug interventions in the integrated group were the followings： （1） the reversible eholinesterase inhibitor hyperzine A for ameliorating the symptoms of dementia; （2） atypical antipsychotic drug of Quetiapine Famarate tablets; （3） antidepressant of serotonin reuptake inhibitor of fluoxetine hydroehloride capsule. At the beginning of intervention and at 3 and 6 months after intervention, The QOL was measured with the quality of life-alzheimer disease scale （QOL-AD）, the activity of daily life with activity of daily life （ADL）, psychiatric symptoms with brief psychiatric rating scale （BPRS）, and the depressive emotion with Hamilton Depression Scale （HAMD）.
RESULTS： The patients in all the groups completed the treatment and measurements, and all were involved in the analysis of results. （1） In the integrated group, the QOL score after interventions was increased, but the scores of MMSE, ADL and HAMD were decreased as compared with those before treatment; In the psychosocial interventions group, the QOL score after interventions was increased, but the score of ADL was decreased as compared with those before treatment; In the control group, the QOL score at 6 months was decreased, but the score of ADL was increased as compared with those in the first evaluation. （2） The difference between the MMSE score at 3 months and that before intervention and that between the MMSE score at 6 months and that before intervention in the integrated group were decreased more significantly as compared with those in the psychosocial interventions group and control group. The difference between the QOL score at 3 months and that before intervention and that between the MMSE score at 6 months and that before intervention in the integrated group and psychosocial interventions group were increased more significantly as compared with those in the control group, and the ADL scores were all decreased more significantly. （3） The score of intervention was positively correlated with the difference of QOL-AD score （r=-0.30, P〈 0.001）, but positively correlated with the difference of ADL score （r =0.27, P 〈 0.001）.
CONCLUSION： In the community support system, drug treatment combined with psychosocial intervention has the best effect in improving the QOL of patients with dementia, followed by the effect of psychosocial intervention alone, there was a gradually aggravated trend in the eontrol group. The integrated interventional pattern should be spread.
出处
《中国临床康复》
CSCD
北大核心
2006年第14期3-6,共4页
Chinese Journal of Clinical Rehabilitation
基金
广东省医学科学技术研究基金立项项目(WSTJJ20031201422228197502195610)
广州市科委重点攻关课题基金资助项目(2000-z-026-01)~~
