奥氮平联合丙戊酸镁缓释片治疗尿毒症脑病所致精神障碍的疗效观察
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摘要
目的探讨奥氮平联合丙戊酸镁缓释片治疗尿毒症脑病所致精神障碍患者的疗效。方法选取2013年3月至2018年6月在湖南省第二人民医院住院的尿毒症脑病所致精神障碍(主要表现为幻觉、被害妄想、躁狂、异常兴奋等精神异常)患者93例,分为合用组(33例)、单用组(30例)及对照组(30例)。对照组患者采用血液净化(每周2次血液透析+1次血液透析滤过治疗)+对症支持治疗,单用组在对照组治疗基础上加用奥氮平,合用组在对照组治疗基础上加用奥氮平+丙戊酸镁缓释片,疗程均为2周。采用阴性及阳性量表(PANSS)评定患者的临床疗效,并以不良反应量表(TESS)评定不良反应。结果合用组治疗1周末、2周末时PANSS评分明显低于单用组及对照组,差异有统计学意义(P<0.05),同时单用组治疗2周末时PANSS评分明显低于对照组,差异有统计学意义(P<0.05);合用组患者精神症状控制更佳,疗效更显著。单用组与合用组TESS评分比较差异无统计学意义(P>0.05)。结论奥氮平联合丙戊酸镁缓释片治疗表现为精神障碍的尿毒症脑病患者显效更快,控制率更高,疗效好且安全,可快速控制患者精神症状,可在临床上推广使用。
Objective To explore the efficacy of olanzapine combined with magnesium valproate sustained release tablets in the treatment of patients with mental disorders caused by uremic encephalopathy. Methods Ninety-three patients with mental disorders caused by uremia encephalopathy(mainly manifested as hallucinations, paranoia, mania, abnormal excitement, etc.), who were admitted to our hospital from March 2013 to June 2018, were selected and divided into three groups: combined group(33 cases), single-use group(30 cases) and control group(30 cases). Patients in the combined group were treated with olanzapine combined with magnesium valproate sustained release tablets plus blood purification(hemodialysis twice + hemodiafiltration once per week) and symptomatic supportive treatment. Patients in the single-use group were treated with olanzapine plus blood purification(hemodialysis once + hemodiafiltration once per week) and symptomatic supportive treatment. Patients in the control group only received blood purification(hemodialysis twice + hemodiafiltration once per week) and symptomatic support treatment. The course of treatment is 2 weeks for all the groups. The clinical efficacy of the patients was assessed by the negative and positive scale(PANSS), and adverse reactions were observed in both the groups. Adverse reactions were assessed by the treatment emergent symptom scale(TESS). Results The PANSS scores in the combined group were significantly lower than those in the single-use group and the control group at weekends 1 and 2 of the treatment course, with difference of statistically significance(P<0.05). And the PANSS scores in the single-use group was significantly lower than in the control group at weekend 2, with difference of statistical significance(P<0.05). The patients in the combined group had better control of mental symptoms and the curative effect was more significant. There was no significant difference in TESS score between the two groups(P>0.05). Conclusions Olanzapine combined with magnesium valproate sustained release tablets for the treatment of uremic encephalopathy patients with mental disorders has more rapid response, higher control rate, and good and safe efficacy, and so can quickly control the patient's mental symptoms. For uremic encephalopathy patients with mental disorders it can be promoted clinically.
Objective To explore the efficacy of olanzapine combined with magnesium valproate sustained release tablets in the treatment of patients with mental disorders caused by uremic encephalopathy. Methods Ninety-three patients with mental disorders caused by uremia encephalopathy(mainly manifested as hallucinations, paranoia, mania, abnormal excitement, etc.), who were admitted to our hospital from March 2013 to June 2018, were selected and divided into three groups: combined group(33 cases), single-use group(30 cases) and control group(30 cases). Patients in the combined group were treated with olanzapine combined with magnesium valproate sustained release tablets plus blood purification(hemodialysis twice + hemodiafiltration once per week) and symptomatic supportive treatment. Patients in the single-use group were treated with olanzapine plus blood purification(hemodialysis once + hemodiafiltration once per week) and symptomatic supportive treatment. Patients in the control group only received blood purification(hemodialysis twice + hemodiafiltration once per week) and symptomatic support treatment. The course of treatment is 2 weeks for all the groups. The clinical efficacy of the patients was assessed by the negative and positive scale(PANSS), and adverse reactions were observed in both the groups. Adverse reactions were assessed by the treatment emergent symptom scale(TESS). Results The PANSS scores in the combined group were significantly lower than those in the single-use group and the control group at weekends 1 and 2 of the treatment course, with difference of statistically significance(P<0.05). And the PANSS scores in the single-use group was significantly lower than in the control group at weekend 2, with difference of statistical significance(P<0.05). The patients in the combined group had better control of mental symptoms and the curative effect was more significant. There was no significant difference in TESS score between the two groups(P>0.05). Conclusions Olanzapine combined with magnesium valproate sustained release tablets for the treatment of uremic encephalopathy patients with mental disorders has more rapid response, higher control rate, and good and safe efficacy, and so can quickly control the patient's mental symptoms. For uremic encephalopathy patients with mental disorders it can be promoted clinically.
引文
[1] 杨显东.奥氮平和利培酮治疗急性期精神分裂症的对照研究[J].医学理论与实践,2012,25(23):2860-2861.
[2] 张瑞霞,武兵.奥氮平治疗脑器质性疾病所致精神障碍的临床效果与安全性分析[J].中国综合临床,2017,33(12):1093-1096.
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[4] 李晓英,吕红波,张永利.丙戊酸镁缓释片合并奥氮平治疗病毒性脑炎所致精神障碍伴兴奋冲动行为对照研究[J].甘肃科技,2011,27(23):152-154.
[5] De Deyn PP,Vanholder R,Eloot S,et al.Guanidino compounds as uremic (neuro)toxins[J].SeminDial,2009,22(4):340-345.
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[7] Enomoto A,Takeda M,Taki K,et al.Interactions of human organic anion as well as cation transporters with indoxyl sulfate[J].Eur J Pharmacol,2003,466(1-2):13-20.
[8] Topczewska-Bruns J,Pawlak D,Chabielska E,et al.Increased levels of 3-hydroxykynurenine in different brain regions of rats with chronic renal insufficiency[J].Brain Res Bull,2002,58(4):423-428.
[9] Vanholder R,De Smet R,Glorieux G,et al.European Uremic Toxin Work Group (EUTox).Review on uremic toxins:classification,concentration,and interindividual variability[J].Kidney Int,2003,63(5):1934-1943.
[10] Davidson RJ,Putnam KM,Larson GL.Dysfunction in the neural circuitry of emotion regulation-a possible prelude to violence[J].Science,2000,289(5479):591-594.
[11] 潘振山,魏冬.奥氮平联合多奈哌齐治疗器质性精神障碍疗效观察[J].临床心身疾病杂志,2014,20(4):106-110.
[12] 陈思明.利培酮联合奥氮平治疗脑器质性精神障碍疗效分析[J].中国实用神经疾病杂志,2015,18(3):35-37.
[13] 李献斌.奥氮平联合小剂量丙戊酸镁缓释片治疗急性期精神分裂症的对照研究[J].临床医药文献杂志,2015,2(16):3225.
[14] 金卫东.双相障碍的药物治疗方案与流程[J].国外医学(精神病学分册),2005,32(2):69-73.
[15] 简炜颖,苗国栋.非典型抗精神病药物联合丙戊酸钠治疗双相躁狂症的疗效与安全性[J].广东医学,2013,34(4):614-616.
[16] 万俊玲.丙戊酸镁缓释片联合奥氮平治疗脑血管病致精神障碍患者的疗效观察[J].中国民康医学,2016,28(12):7-9.
[2] 张瑞霞,武兵.奥氮平治疗脑器质性疾病所致精神障碍的临床效果与安全性分析[J].中国综合临床,2017,33(12):1093-1096.
[3] 宋丽波,吕高明.丙戊酸镁缓释片联合奥氮平对脑外伤后伴躁狂精神障碍的治疗效果观察[J].中国医药指南,2017,15(15):83-84.
[4] 李晓英,吕红波,张永利.丙戊酸镁缓释片合并奥氮平治疗病毒性脑炎所致精神障碍伴兴奋冲动行为对照研究[J].甘肃科技,2011,27(23):152-154.
[5] De Deyn PP,Vanholder R,Eloot S,et al.Guanidino compounds as uremic (neuro)toxins[J].SeminDial,2009,22(4):340-345.
[6] De Deyn PP,Vanholder R,D'Hooge R.Nitric oxide in uremia:effects of several potentially toxic guanidino compounds[J].Kidney Int Suppl,2003,84(9):S25-S28.
[7] Enomoto A,Takeda M,Taki K,et al.Interactions of human organic anion as well as cation transporters with indoxyl sulfate[J].Eur J Pharmacol,2003,466(1-2):13-20.
[8] Topczewska-Bruns J,Pawlak D,Chabielska E,et al.Increased levels of 3-hydroxykynurenine in different brain regions of rats with chronic renal insufficiency[J].Brain Res Bull,2002,58(4):423-428.
[9] Vanholder R,De Smet R,Glorieux G,et al.European Uremic Toxin Work Group (EUTox).Review on uremic toxins:classification,concentration,and interindividual variability[J].Kidney Int,2003,63(5):1934-1943.
[10] Davidson RJ,Putnam KM,Larson GL.Dysfunction in the neural circuitry of emotion regulation-a possible prelude to violence[J].Science,2000,289(5479):591-594.
[11] 潘振山,魏冬.奥氮平联合多奈哌齐治疗器质性精神障碍疗效观察[J].临床心身疾病杂志,2014,20(4):106-110.
[12] 陈思明.利培酮联合奥氮平治疗脑器质性精神障碍疗效分析[J].中国实用神经疾病杂志,2015,18(3):35-37.
[13] 李献斌.奥氮平联合小剂量丙戊酸镁缓释片治疗急性期精神分裂症的对照研究[J].临床医药文献杂志,2015,2(16):3225.
[14] 金卫东.双相障碍的药物治疗方案与流程[J].国外医学(精神病学分册),2005,32(2):69-73.
[15] 简炜颖,苗国栋.非典型抗精神病药物联合丙戊酸钠治疗双相躁狂症的疗效与安全性[J].广东医学,2013,34(4):614-616.
[16] 万俊玲.丙戊酸镁缓释片联合奥氮平治疗脑血管病致精神障碍患者的疗效观察[J].中国民康医学,2016,28(12):7-9.