奥氮平与无抽搐电休克治疗女性躁狂发作的随机对照研究  

A Randomized,Controlled Trial for Evaluating the Efficacy and Safety of Olanzapine and MECT in the Treatment of Female Mania

作　　者：罗炯[1,2,3,4] 王雪 姜玮 赵茜 史晓宁 王刚 

机构地区：[1]首都医科大学附属北京安定医院 [2]精神疾病诊断与治疗北京市重点实验室 [3]首都医科大学精神病学系 [4]北京市脑重大疾病研究院抑郁症研究所,北京中国100088

出　　处：《中国健康心理学杂志》2014年第10期1465-1467,共3页China Journal of Health Psychology

摘　　要：目的比较奥氮平冲击疗法与无抽搐电休克治疗（MECT）对女性躁狂发作的疗效和安全性。方法 50例住院女性患者随机分为奥氮平组和MECT组,奥氮平组每晚服药,第1天20mg/d,以后依据患者耐受情况调整到15-30mg/d。MECT组：在第1天,第2天,第3天,第5天,第7天,第9天行无抽搐电休克治疗,共6次。在基线,第1天,第3天,第6天,第9天,第14天,第21天分别采用杨氏躁狂量表（YMRS）评估疗效,采用不良反应量表（TESS）评定不良反应。基线和终点进行血常规,尿常规,血生化,甲状腺功能及心电图检查,以评价安全性。结果采用重复测量的方差分析比较两组治疗前后YMRS分值变化以及组间有无差异,结果显示奥氮平组治疗后YMRS总分显著下降（F=274.7,P〈0.01）,MECT组治疗后YMRS总分也显著下降（F=350.9,P〈0.01）,两组组间比较无显著差异（F=2.0,P=0.163）。奥氮平组有效21例,MECT组有效23例,两组间无显著性差异（χ2=0.758,P〉0.05）;奥氮平组痊愈18例,MECT组痊愈19例,两组间也无显著性差异（χ2=0.104,P〉0.05）。两组之间不良事件的总发生率没有显著差异（P〉0.05）。结论奥氮平冲击疗法对急性躁狂发作有效,安全性好,与MECT相比无明显差异,是一种安全、有效、符合快速综合治疗要求的治疗急性躁狂发作的新方法。Objective To compare the clinical efficacy and safety of olanzapine and modified electroconvulsive therapy （ MECT ） in the treatment of female mania .Methods Fifty female inpatients with mania were treated to olanzapine or MECT in a three -week randomized,controlled trial.Olanzapine of 20mg was taken by patients in the first day ,later to 15-30mg/d according to the patients＇toler-ance.MECT was done in the first day,the second day,the third day,the fifth day,the seventh day,and the ninth day.The Young Mania Rating Scale（YMRS）was utilized for evaluating clinical efficacy ,and the Treatment Emergent Symptom Scale （TESS）was utilized for evaluating the safety at prior treatment ,the first day,the third day,the sixth day,the ninth day,the fourteenth day and the twenty -first day.The changes of blood tests ,urine tests,biochemical index ,thyroid function and electrocardiogram were determined before and at the end of treatments .Results Compared the changes of YMRS scores between two groups before and after the treatments using repeated measures analysis of variance .The results showed a significant decrease in YMRS total scores after olanzapine treatments （F=274.7,P〈0.01）.YMRS total scores also decreased significantly after MECT treatments （F=350.9,P〈0.01）.There were no significant differences between two groups .21 cases were effective in olanzapine group and 23 cases were effective in MECT group .There were no significant differences between two groups （χ2 =0.758,P〉0.05）.18 cases were clinical remission in olanzapine group and 19 cases were clin-ical remission in MECT group.There were no significant differences between two groups （χ2 =0.104,P〉0.05）.There were no significant differences in side effect between two groups （P〉0.05）.Conclusion The acute manic episode is effectively treated by large dose of olanzapine with the high safety .The efficacy of olanzapine is similar with MECT in the treatment of mania .It＇s a safe,effective and rapid treatment of acute manic episode

关 键 词：躁狂发作 奥氮平 无抽搐电休克治疗 精神病学 

分 类 号：R749.3[医药卫生—神经病学与精神病学] R749.053[医药卫生—临床医学]