氟哌噻吨美利曲辛联合认知行为疗法治疗癔球症91例分析  

Analysis of flupentixol and melitracen combined with cognitive behavior therapy in the treatment of 91 cases of globus sensation

作　　者：崔征[1] 侯鹏飞[1] 刘伟[1] CUI Zheng;HOU Pengfei;LIU Wei(Gastroenterology Department,Puyang Oilfield General Hospital,Puyang,Henan 457000,China)

机构地区：[1]濮阳市油田总医院消化内科,河南濮阳457000

出　　处：《安徽医药》2022年第6期1244-1249,共6页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨氟哌噻吨美利曲辛联合认知行为疗法治疗癔球症的临床价值。方法选择2017年9月至2019年8月濮阳市油田总医院收治的182例癔球症病人,按随机数字表法分为对照组与观察组,每组91例,两组均给予认知行为疗法,在此基础上对照组采用埃索美拉唑、莫沙必利等抑酸、促动力学治疗,观察组在对照组基础上加用氟哌噻吨美利曲辛治疗,比较两组治疗前后癔球症症状评分量表(GETS)的变化,采用焦虑自评量表(SAS)、抑郁自评量表(SDS)及匹兹堡睡眠质量指数(PSQI)评定病人心理状态及睡眠质量的变化;并采用胃肠动力学测定仪进行食管上括约肌运动功能;采血测定治疗前后神经肽Y、P物质、降钙素基因相关肽(CGRP)等脑肠肽指标的变化;比较两组治疗不良反应发生情况;并采用Pearson相关性分析评估癔球症病人GETS评分与食管上括约肌运动功能指标的相关性。结果治疗12周,两组GETS表、SAS表、SDS表、PSQI评分均降低(P<0.05),观察组降低幅度[(6.36±2.11)分、(46.63±5.14)分、(44.52±4.15)分、(4.71±0.65)分]高于对照组[(9.26±3.05)分、(49.06±3.75)分、(48.14±3.97)分、(5.23±0.78)分](P<0.05);治疗12周,两组食管上括约肌静息压降低(P<0.05),观察组静息压(52.25±10.65)mmHg,低于对照组(57.85±9.63)mmHg(P<0.05);治疗12周,两组神经肽Y上升,P物质及CGRP均降低(P<0.05),观察组P物质及CGRP[(665.14±98.52)ng/L、(181.15±23.63)ng/L]低于对照组[(750.63±49.87)ng/L、(210.89±16.25)ng/L],神经肽Y高于对照组[(780.25±30.06)ng/L比(706.25±50.14)ng/L](P<0.05);两组治疗不良反应发生率(8.79%比7.69%)比较差异无统计学意义(P>0.05);癔球症病人GETS评分与食管上括约肌静息压呈正相关(r=0.46,P<0.05)。结论氟哌噻吨美利曲辛联合认知行为疗法可改善癔球症病人症状,减轻焦虑、抑郁程度,改善病人睡眠质量,降低食管上括约肌静息压,调节脑肠肽轴平衡,安全有效,治疗价Objective To explore the clinical value of flupentixol and melitracen combined with cognitive behavior therapy in the treatment of globus sensation.Methods A total of 182 patients with globus sensation admitted to Puyang Oilfield General Hospital from September 2017 to August 2019 were recruited as the study subjects.They were divided into control group and observation group by the random number table method,with 91 cases in each group.Both groups of patients were given cognitive behavioral therapy.On this basis,patients in the control group were treated with esomeprazole,mosapride and other acid-suppressive and prokinetic treatments.The observation group were treated with flupentixol and melitracen on the basis of the treatments for control group.Changes in the Glasgow Edinburgh Throat Scale(GETS)scores of the 2 groups before and after treatment were compared.The Self-rating Anxiety Scale(SAS),Self-rating Depression Scale(SDS)and Pittsburgh Sleep Quality Index(PSQI)were used to assess changes in patients'psychological status and sleep quality.The gastrointestinal kinetics measuring instrument was used to measure the motor function of upper esophageal sphincter.Blood samples were collected to determine changes in brain-gut peptide indexes such as neuropeptide Y(NPY),substance P(SP)and calcitonin gene-related peptide(CGRP)before and after treatment.The incidence rates of adverse reactions in the 2 groups were compared.Pearson correlation analysis was used to evaluate the correlation between the GEST score and motor function index of superior esophageal sphincter in patients with globus sensation.Results After 12 weeks of treatment,GETS,SAS,SDS and PSQI scores of both groups were decreased(P<0.05),and the decreases of the observation group[(6.36±2.11)points,(46.63±5.14)points,(44.52±4.15)points,(4.71±0.65)points]were larger than those of the control group[(9.26±3.05)points,(49.06±3.75)points,(48.14±3.97)points,(5.23±0.78)points](P<0.05).After 12 weeks of treatment,upper esophageal sphincter resting pressure

关 键 词：转换障碍 认知疗法 行为疗法 氟哌噻吨 美利曲辛 食管括约肌 上段 癔球症 

分 类 号：R571[医药卫生—消化系统]