利培酮合并氟哌啶醇治疗精神分裂症激越行为

目的比较短期肌注氟哌啶醇或氯硝安定合用利培酮及氟哌啶醇肌肉注射治疗急性期精神分裂症患者兴奋激越行为的疗效及安全性。方法将符合CCMD-3诊断标准的165名新入院伴有兴奋冲动行为的精神分裂症患者随机分组,进入利培酮合并氟哌啶醇组(A组)、利培酮合并氯硝安定组(B组)和氟哌啶醇组(C组),观察期4周。采用阳性及阴性评定量表(PANSS)兴奋激越因子评定疗效,采用副作用量表(TESS)评定药物不良反应。结果与入院测评基线比较,各组患者PANSS-兴奋因子分均显著下降;治疗1周后各组组间兴奋因子得分有显著性差异(F=5.41,P0.01),A、C两组疗效优于B组。但以PANSS-兴奋激越项目减分率分级标准计算疗效的比较在5天末(χ2=1.526,P0.05)、1周末(χ2=1.529,P0.05)、2周末(χ2=1.335,P0.05)发现差异无统计学意义。TESS量表不良反应发生率比较,3组患者在肌强直(χ2=22.388,P0.01)、震颤(χ2=8.633,P0.05)、扭转性运动(χ2=1.335,P0.05)及静坐不能(χ2=6.341,P0.05)等椎体外系方面差异有统计学意义。结论利培酮合并氟哌啶醇短期肌注提高了患者的耐受性,能迅速有效地控制急性期精神分裂症的兴奋激越行为,可作为临床处理精神分裂症急性期兴奋激越行为的重要手段之一。

Effectiveness of Risperidone Combining Short-term Intramuscular Haloperidol in the Treatment of the Agitated Behavior of Psychotic Patients

Objective To explore the efficacy and adverse events of risperidone combining short-term intramuscular haloperidol or clonazepam and intramuscular haloperidol in the treatment of the agitated behavior of patients in the acute phase of schizophrenia .Meth-ods 165 patients associated with impulsive behavior who met the diagnostic criteria of CCMD -3 for schizophrenia were randomly divid-ed into three groups .Group A was treated with risperidone combining short-term intramuscular haloperidol ,B with risperidone combining short-term intramuscular donazepam and C with only haolperidol for 2 weeks.The efficacy and adverse events were evaluated by PANSS and TESS.Results After treatment,compared to baseline ,the factor-scores of excitement of PANSS in each group were reduced signifi-cantly.There were significant differences between the three groups on the score of the factor -scores of excitement of PANSS by the end of 1st week（（F=5.41,P〈0.01）,and the efficacy of the group A and C was better than that of group B .At the meanwhile no significant differences were found between the three group when taking the reduce rate of factor -scores of excitement of PANSS as the standard of ef-ficacy level by the end of 5th day（χ2 =1.526,P〉0.05）,1st week（χ2 =1.529,P〉0.05）and 2nd week（χ2 =1.335,P〉0.05）.There were significant differences between three groups on the incidence rate of extrapyramidal symptoms ,such as myotonia（χ2 =22.388,P〈0.01）,tremor（χ2 =8.633,P〈0.05）,torsion dystonia（χ2 =1.335,P〈0.05） and drug-induced akathisia （χ2 =6.341,P〈0.05）. Conclusion Risperidone combined short-term haloperidol intramuscular can greatly improve patient＇s tolerability and control agitated behavior of patients in the acute phase of schizophrenia quickly and efficiently .It can be a good means for them .