丙戊酸钠联合齐拉西酮治疗难治性精神分裂症的效果分析
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[摘要] 目的 探讨丙戊酸钠联合齐拉西酮治疗难治性精神分裂症的疗效。 方法 将72例患者随机分为观察组和对照组各36例，对照组给予齐拉西酮口服，20 mg/次，每日2次，根据病情可逐渐增加到80 mg/次，每日2次。观察组加用丙戊酸钠口服，300 mg/次，每日2~3次。疗程均为8周。在治疗前和治疗期评价疗效和不良反应。 结果 观察组有效率为77.8%，明显优于对照组的52.7%，差异有统计学意义(χ2 = 4.964，P = 0.026)。不同治疗阶段的PANSS评分与治疗前相比均有不同程度改善，同期观察组评分明显优于对照组(P < 0.05)。两组患者的药物不良反应率无明显差异。 结论 丙戊酸钠联合齐拉西酮治疗难治性精神分裂症可以提高疗效，安全性好，值得在临床推广。
[关键词] 难治性精神分裂症；齐拉西酮；丙戊酸钠；联合用药
[中图分类号] R971+.41 [文献标识码] A [文章编号] 1674-4721(2012)02(a)-0073-02
Effect analysis of Valproic acid sodium jointed with Ziprasidone in the treatment of refractory schizophrenia
MA Tingbin
Zhishan Hospital of Yongzhou City in Hunan Province, Yongzhou 425113, China
[Abstract] Objective To explore the effect of Valproic acid sodium jointed with ziprasidone in the treatment of refractory schizophrenia. Methods Seventy two patients were randomly divided into the observation group and the control group with 36 cases in each group, the control group was given ziprasidone by oral, 20 mg once, 2 times a day; according to the condition, it could be gradually increased to 80 mg once, 2 times a day. Observation group was added with Valproic acid sodium by oral, 300 mg once 2 - 3 times a day. The course of treatment was 8 weeks. The efficacy and adverse reactions were evaluated before and after treatment. Results The effect rate of the observation group was 77.8%, which was significantly better than that in the control group of 52.7%, the difference was statistically significant (χ2 = 4.964, P = 0.026 ). PANSS score in different treatment stages showed improvement over the same period compared with before, but the observation group was significantly better than that of the control group ( P < 0.05 ). Adverse drug reaction rate in two groups was not significantly different. Conclusion Valproic acid sodium jointed with ziprasidone in the treatment of refractory schizophrenia can improve the efficacy, with the high safety which is worthy of spreading clinically.
[Key words] Refractory schizophrenia; Ziprasidone; Valproic acid sodium; Drug combination
精神分裂症是一组病因未明的精神疾病，以精神活动和环境不协调为特征，常缓慢起病，病程迁延，可发展为难治性精神分裂症，其的治愈率低，预后较差，给患者带来极大的负担[1]。本院采用丙戊酸钠联合齐拉西酮治疗难治性精神分裂症，取得了良好的疗效，现报道如下：
1 资料与方法
1.1 一般资料
选择本院精神科2008年1月~2010年12月患者72例，其中，男38例，女34例；年龄21~57岁，平均35.6岁；病程6~28年，平均11.3年。均符合CCMD-3诊断标准[2]。经3种或3种以上抗精神病药(除齐拉西酮外)系统治疗3个月以上无明显疗效；阳性与阴性症状量表(PANSS)总分≥60分；排除严重躯体疾病、酒精或药物依赖及妊娠和哺乳期患者。随机分为观察组和对照组，每组各36例。两组患者的年龄、性别、病程等差异无统计学意义，具有可比性。
1.2 治疗方法
治疗前停药清洗1周。对照组给予齐拉西酮口服，20 mg/次，每日2次；根据病情可逐渐增加到80 mg/次，每日2次。观察组在对照组用药的基础上给予丙戊酸钠口服，300 mg/次，每日2~3次。治疗期间不用其他抗精神病药物，疗程均为8周。
1.3 疗效评价
在治疗前和治疗后第2、4、6、8 周末分别对患者用PANSS量表评定，根据量表减分率判定疗效，减分率≥75%为痊愈，50%~74%为显著好转，25%~49%为好转， < 25%为无效。有效=痊愈+显著好转+好转。采用副反应量表(TESS)评定药物不良反应。
1.4 统计学方法
应用SPSS 13.0统计软件分析数据，计量资料描述以均数±标准差表示，分类指标的描述以例数及百分数表示；分组资料中计量资料比较用t检验；率的比较采用χ2检验，P < 0.05为差异有统计学意义。
2 结果
2.1 两组患者疗效比较 ......
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