立体定向术对阿片类药物依赖者心理障碍治疗前后的对照研究  

Comparative study of stereotactic surgery for mental disorder of opioid-dependent patients

作　　者：吕博川[1] 李智勇[2] 杜鹏[2] 魏学忠[2] 薛洪利[2] 

机构地区：[1]中国人民解放军沈阳军区总医院神经外科神经心理室,辽宁沈阳110016 [2]中国人民解放军沈阳军区总医院神经外科,辽宁沈阳110016

出　　处：《中国微侵袭神经外科杂志》2007年第8期340-343,共4页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的观察立体定向手术治疗对阿片类药物依赖病人术后近期病理性心理症状的影响。方法选择自愿要求手术的戒毒病人26例,采用90项症状自评量表(SCL-90)进行评估。治疗前后选择自身配对t检验,治疗前后与国内常模比较、治疗后与强制戒毒、冷火鸡脱毒、美沙酮脱毒治疗后比较采用单样本t检验。结果术后73.1%病人总体病理性心理障碍症状完全改善。57.7%病人的躯体不适症状、73.1%病人的强迫症状得到矫治。手术消除了80.8%病人的抑郁症状、69.2%病人的焦虑症状。同时手术也改善了69.2%病人的人际关系、57.7%病人的恐怖、73.1%病人的敌对、61.5%病人的偏执、57.7%病人的精神病和65.4%病人其他不良症状。与常模比较,术前SCL-90各项差异均有统计学意义(P<0.05),术后仅躯体症状差异有统计学意义(P<0.001)。与强制戒毒组比较,术后SCL-90各项差异均有统计学意义(P<0.05);与冷火鸡组比较,仅躯体症状差异有统计学意义;与美沙酮组比较,躯体症状、抑郁、焦虑差异有统计学意义。结论手术能够不同程度地矫治阿片类药物依赖病人的病理性心理障碍,且近期疗效好于强制戒毒、冷火鸡和美沙酮疗法。Objective To observe the effect of stereotactic surgery on pathopsychological symptoms in the recent period after surgery in opioid-dependent patients. Methods A total of 26 volunteers underwent stereotactic surgery for treating opiate dependence were recruited, and were evaluated using Symptom Checklist 90 （SCL-90） for pathopsychological symptoms, Paired-sample t test was used to compare the patients before and after the treatment. One-sample t test was used for the comparison between the patients and domestic norms before and after the treatment, and for the comparison between surgery treatment and compulsive treatment, detoxification with natural withdrawal （cold turkey） and methadone detoxification. Results After surgery, the pathological mental disorder symptoms completely improved in 73.1% of patients, and physical discomforts and obsessive-compulsive symptoms were corrected in 57.7% and 73.1% of the patients respectively. The stvreotactic surgery eliminated depression in 80.8% of patients and anxiety in 69.2%. Meanwhile many improvements were presented, such as interpersonal relationship in 69.2% of patients, phobia in 57.7%, hostility in 73.1%, paranoid ideation in 61.5%, psychosis in 57.7%, and other symptoms in 65.4%. There were significant differences in SCL-90 scores between domestic norms and preoperative patients （P〈0.05）, and only in somatization scores between domestic norms and postoperative patients （P〈0.001）. There were significant differences in SCL-90 scores between sterotactic surgery and compulsive treatment （P〈0.05）, only in somatization scores between stereotactic surgery and cold turkey, and in somatization scores, depression and anxiety between stereotactic surgery and methadone detoxification. Conclusion Compared with compulsive treatment, atment, cold turkey and methadone detoxification, stereotactic surgery displays obviously better therapeutic effects on the pathopsychological disorder of opioid-dependent patients in a short-term period.

关 键 词：阿片相关性障碍 放射外科手术 症状自评量表 心理障碍 精神病性 

分 类 号：R749.64[医药卫生—神经病学与精神病学]