重复经颅磁刺激与无抽搐电休克联合利培酮治疗流浪难治性精神分裂症患者的临床对照研究  

A clinical controlled study on repetitive transcranial magnetic stimulation and modified electroconvulsive therapy combined with risperidone in the treatment of vagabond patients with treatment-resistant schizophrenia

作　　者：李启斌 陶领钢[1,2] 石顺治 刘训 

机构地区：[1]广西桂林市精神卫生中心,广西桂林541001 [2]桂林医学院,广西桂林541001

出　　处：《现代中西医结合杂志》2018年第9期918-921,941,共5页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：广西卫生厅自筹课题科研项目(Z2014537)

摘　　要：目的探讨重复经颅磁刺激与无抽搐电休克联合利培酮治疗流浪难治性精神分裂症患者的临床疗效和安全性。方法 90例流浪难治性精神分裂症患者随机分为研究组和对照组各45例。研究组患者采用重复经颅磁刺激联合利培酮治疗,对照组患者采用无抽搐电休克联合利培酮治疗,均观察8周。采用阳性症状和阴性症状量表(PANSS)评估疗效,采用韦氏记忆量表(WMS)中的再认、图片、联想及背数4个项目进行短期记忆测定。于治疗前及治疗1,2,4,8周末各评定上述量表1次。对比分析2组治疗后的临床疗效以及不良反应发生情况。结果对照组脱落2例,研究组无脱落。2组总有效率比较差异无统计学意义(2=0.045,P>0.05)。治疗后,2组PANSS总分及各因子分均显著下降(P均<0.05),但2组间同期比较差异无统计学意义(P均>0.05)。对照组仅第1周末WMS各项评分显著低于治疗前(P均<0.05),其他时间点及研究组各项WMS评分均无显著变化(P均>0.05)。2组间WMS各项评分比较差异均无统计学意义(P均>0.05)。结论重复经颅磁刺激联合利培酮治疗流浪难治性精神分裂症患者的临床疗效与无抽搐电休克联合利培酮治疗相似,且安全可靠,可以在临床上广泛应用。Objective It is to investigate the clinical efficacy and safety of repetitive transcranial magnetic stimulation( r TMS) and modified electroconvulsive therapy( MECT) combined with risperidone in the treatment of vagabond patients with treatment-resistant schizophrenia( TRS). Methods Ninety cases of patients with TRS was randomly divided into study group and control group,each of 45 cases. The patients were treated with r TMS and risperidone in the study group,and with MECT and risperidone in the control group. All of them were observed for 8 weeks. The curative effects were evaluated by positive symptoms and negative symptom scale( PANSS). Four items of recognition,picture,association and back number in Wechsler Memory Scale( WMS) were used for short-term memory measurement. The above scales were assessed before treatment and after 1-,2-,4-,and 8-week of treatment. The clinical effect and the incidence of adverse reactions were compared and analyzed in the two groups after treatment. Results Two cases were lost in the control group,and the study group did not fall off. There was not significant difference in total effective rate between the two groups( P > 0. 05). After treatment,the total scores and the factors scores of PANSS were significantly decreased in the two groups( all P < 0. 05),but there was no significant difference between the two groups( P > 0. 05). In the control group,the scores of WMS in the first weekend were significantly lower than that before the treatment( all P < 0. 05),but there were no significant changes in WMS scores of the other time points and in the observation group( all P > 0. 05). There was no significant difference in the scores of WMS between the two groups( P > 0. 05). Conclusion The clinical efficacy of r TMS combined with risperidone in the treatment of vagabond patients with TRS is similar to that of MECT combined with risperidone,it is safe and reliable,and can be widely applied in clinic.

关 键 词：重复经颅磁刺激 无抽搐电休克 流浪难治性精神分裂症 利培酮 

分 类 号：R749.3[医药卫生—神经病学与精神病学]