Abstract
The aim of the study was to evaluate the effectiveness of psychological (adherence to treatment) and accompanying drug therapy depending on the form of pulmonary tuberculosis. The results of complex therapy of 326 patients with various forms of pulmonary tuberculosis are considered. All patients received etiotropic treatment, taking into account the sensitivity of the pathogen to anti-tuberculosis drugs, as well as support therapy, including psychological support and, if indicated, hepatoprotective therapy with Remaxol. When analyzing the dependence of the psychoemotional state of patients on the form of the tuberculous process in the lungs, it was noted that high adherence to therapy was observed in one third of patients in all groups (DTL — 26.1%, ITL — 28.6%, FCTL — 32.8% and ATL — 31.8%, respectively, P>0.05). The results obtained may be associated with a high level of resistance of mycobacterium tuberculosis excreted from pa tients: out of 232 patients with low adherence to treatment (NUP and UUP), 97 (36.2%) showed drug resistance of the pathogen to two or more etiotropic drugs, which, in turn, caused prescription of reserve drugs. Thus, the determination of the level of adherence to treatment is justified and is aimed at correcting the psychological support of patients with pulmonary tuberculosis, which makes it possible to increase the effectiveness of therapy in these patients. The appointment of the latter in a number of patients led to the development of hepatotoxic reactions, which served as the basis for the inclusion in the therapy regimens of the accompaniment of Remaxol (intravenous drip of 400 ml, course No. 5–7). Pronounced hepatoprotective (improved transaminase parameters) and insignificant immunoprotective (positive dynamics of the cytokine profile) effects were noted during treatment. The noted changes in the immunogram can be associated with the proven antioxidant and membrane stabilizing effect of succinic acid, which is part of Remaxol. These changes require further research.
Highlights
КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯ И ПРАКТИКА tients: out of 232 patients with low adherence to treatment (NUP and UUP), 97 (36.2%) showed drug resistance of the pathogen to two or more etiotropic drugs, which, in turn, caused prescription of reserve drugs
The aim of the study was to evaluate the effectiveness of psychological and accompanying drug therapy depending on the form of pulmonary tuberculosis
All patients received etiotropic treatment, taking into account the sensitivity of the pathogen to anti-tuberculosis drugs, as well as support therapy, including psychological support and, if indicated, hepatoprotective therapy with Remaxol.When analyzing the dependence of the psychoemotional state of patients on the form of the tuberculous process in the lungs, it was noted that high adherence to therapy was observed in one third of patients in all groups (DTL — 26.1%, ITL — 28.6%, FCTL — 32.8% and ATL — 31.8%, respectively, P>0.05)
Summary
Проанализированы данные 326 пациентов, находившихся на стационарном лечении в отделениях ОБУЗ «Областной клинический противотуберкулезный диспансер» комитета здравоохранения Курской области (ОБУЗ «ОКПТД»). Перед началом терапии определяли уровень приверженности больных лечению (ПБЛ) по авторской методике [12], в основе которой тестирование пациента по специальной анкете и определение наличия факторов риска (стенов): стресс, фрустрация, стигматизация, внушаемость, пристрастие к алкоголю, социально-психологический статус, побочные реакции на лечение, отсутствие эффекта лечения, не сложившиеся взаимоотношения с медицинским персоналом, экономическое неблагополучие. Низкий уровень (НУП) — неудовлетворительная приверженность лечению, склонность к нарушениям больничного режима, отсутствие эффекта лечения, частые рецидивы и обострения. Удовлетворительный уровень (УУП) — умеренные нарушения больничного режима в экстремальных ситуациях, плохие результаты терапии, редкие рецидивы и обострения. Определялась степень влияния выявленных факторов (стенов) на приверженность лечению с целью коррекции (психологической и медикаментозной) основного курса этиотропной терапии. У пациентов с НУП и УУП и прогнозом неблагоприятного исхода терапии рекомендовалось интенсификация психологического сопровождения с использованием применением психосоматических методик коррекции состояния. Доверительный интервал (ДИ) представлял собой диапазон значений, который с определённой вероятностью (а=0,05 или 95%) включал в себя настоящее популяционное значение, р
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