第一代和第二代抗精神病药物的临床疗效及不良反应研究

目的比较第一代抗精神病药物（FGA）和第二代抗精神病药物（SGA）的临床疗效及不良反应。方法将102例精神分裂症患者分为两组，FGA组48例，SGA组54例，分别给予FGA和SGA治疗。采用副反应量表评定不良反应发生率及严重程度。治疗效果由主管医师按4级疗效标准在患者出院时加以综合评定。结果两组总体疗效无显著性差异（U=1．12，P〉0．05）。SGA组引起血糖升高、体重增加的发生率显著高于FGA组（P均〈0.05），肌强直、震颤、扭转性痉挛、口干、体位性低血压及心动过速的发生率显著低于FGA组（P均〈0.05）。副反应量表评分，SGA组情绪抑郁、活动增多或减退、血糖升高、唾液增多、腹泻、心动过速因子分显著高于FGA组（P〈0．05或0．01），兴奋或激越、嗜睡、血象异常、肝功异常、震颤、扭转性痉挛、静坐不能、口干、鼻塞、视力模糊、便秘、体位性低血压、心动过速、心电图异常、皮疹、体重增加因子分均显著低于FGA组（P〈0．05或0．01）。结论SGA和FGA常规有效剂量的抗精神病作用疗效相当，但不良反应各有侧重；在临床用药中应客观评价SGA，应根据病员状况合理选用药物。

Clinical efficacy and adverse effects of first and second generation antipsychotics

Objective To compare the clinical efficacy and adverse reactions of first generation antipsychotics(FGA)and second generation antipsychotics(SGA).Methods 102 schizophrenics were divided into FGA(n=48)and SGA group(n=54).Incidences and severity of adverse effects were assessed with the Treatment Emergent Symptom Scale(TESS).Therapeutic effects were comprehensively assessed by attending doctors according to 4-grade criterion of theraprutic effect at discharge.Results There was no significant difference in total effect between the 2 groups(P>0.05).The incidence of BG elevation and weight gain were significantly higher(P<0.05)and those of myotonia,tremor,streph-spasm,dry mouth,postural hypotension and tachycardia lower(P<0.05).The TESS scores of emotional depression,hyperactivity or hypoactivity,BG elevation,saliva increase,diarrhea and tachycardia were significantly higher(P<0.05 or 0.01)and those of excitement or agitation,drowsiness,hemogram,hepatic and ECG dysfunction,rash and weight gain lower(P<0.05 or 0.01)in the SGA than in the FGA group.Conclusion Routine curative dose SGA has therapeutic equivalence to FGA but main adverse effects are different;the SGA should be objectively assessed clinically and drugs rationally selected according to patients' conditions.