米氮平联合小剂量奥氮平治疗流浪抑郁症伴失眠患者的对照研究  

A control study of Mirtazapine combined with small dose of Olanzapine in the treatment of the vagrant depression with insomnia

作　　者：李启斌 陶领钢[1,2] 周云 杨涌 谢振国[1] 周琳玲 LI Qibin;TAO Linggang;ZHOU Yun;YANG Yong;XIE Zhengguo;ZHOU Linling(Guilin Mental Health Center,Psychological Hygiene of Guilin Medical University,Guilin 541001,China;Department of Mental and Psychological Hygiene of Guilin Medical University,Guilin 541001,China)

机构地区：[1]广西桂林市精神卫生中心 [2]桂林医学院精神心理卫生学教研室,桂林541001

出　　处：《右江医学》2018年第1期26-29,共4页Chinese Youjiang Medical Journal

基　　金：广西卫生厅自筹课题科研项目(Z2014537)

摘　　要：目的探讨米氮平联合小剂量奥氮平治疗流浪抑郁症伴失眠患者的临床效果和安全性。方法选取2014年3月至2016年11月桂林市精神卫生中心救助科收治的流浪抑郁症伴失眠患者96例。于治疗前及治疗1、2、4、6、8周后采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、匹兹堡睡眠质量指数(PSQI)及副反应量表(TESS)评定疗效及不良反应。结果治疗8周后,研究组抑郁治疗总有效率为89.58%,高于对照组的64.58%,差异有统计学意义(P<0.01);两组患者治疗1、2、4、6、8周后的HAMD、HAMA、PSQI各次评分在治疗时间效应上均较治疗前明显下降(P<0.05);两组之间的HAMD评分结果比较(F=55.23,P<0.001),HAMA评分结果比较(F=32.11,P<0.001),PSQI总分结果比较(F=99.11,P<0.001),差异有统计学意义。两组失眠症状治疗情况比较差异有统计学意义(χ2=4.94,P=0.026)。两组的处理因素与治疗时间之间的交互作用的比较差异无统计学意义(F=1.52,P=0.131)。两组不良反应相当(χ2=0.066,P=0.080)。结论米氮平联合小剂量奥氮平治疗流浪抑郁症伴失眠患者疗效优于米氮平单一用药,该疗法能明确改善患者的抑郁症状和睡眠质量,安全性高,值得临床推荐。Objective To investigate the effect and safety of Mirtazapine combined with small dose of Olanzapine in the treatment of vagrant depression with insomnia.Methods 96 cases of vagrant depression with insomnia treated in the Rescue Department of Guilin Mental Health Center from March,2014 to November,2016 were selected.Then,effects and adverse reactions were assessed with Hamilton Rating Scales of Depression(HAMD),Hamilton Anxiety Scale(HAMA),Pittsburgh Sleep Quality Index(PSQI)and Treatment Emergent Symptom Scale(TESS)before treatment and 1,2,4,6 and 8 weeks after treatment,respectively.Results 8 weeks after treatment,the total effective rate of depression treatment in the study group was 89.58%,which was higher than that of the control group(64.58%),difference was statistically significant(P<0.01).1,2,4,6 and 8 weeks after treatment,the scores of HAMD,HAMA and PSQI in the two groups were significantly lower than those before treatment(P<0.05).Difference of HAMD score(F=55.23,P<0.001),HAMA score(F=32.11,P<0.001)and PSQI total score(F=99.11,P<0.001)between the two groups was statistically significant.Difference of the treatment of insomnia symptoms between the two groups was statistically significant(χ2=4.94,P=0.026).There was no statistically significant difference in interaction between treatment factors and treatment time between the two groups(F=1.52,P=0.131).Adverse reactions were equivalent between the two groups(χ2=0.066,P=0.080).Conclusion Mirtazapine combined with small dose of Olanzapine in the treatment of vagrant depression with insomnia is better than single use of Mirtazapine,which can clearly improve the depressive symptoms and sleep quality of the patients with high safety,and thus it is worthy of clinical recommendation.

关 键 词：流浪抑郁症 失眠 米氮平 奥氮平 

分 类 号：R749.41[医药卫生—神经病学与精神病学]