摘要
目的:观察丙戊酸镁与利培酮治疗老年期痴呆激越行为的疗效及安全性。方法:于2003-12/2005-12选择新乡医学院第二附属医院老年科住院及门诊患者中符合中国精神疾病分类与诊断标准的阿尔茨海默病及血管性痴呆患者87例。以接诊先后顺序编号分为两组,单号为丙戊酸镁组(n=43),双号为利培酮组(n=44)。丙戊酸镁组予以0.2g/d,1次/d,口服。视病情情况在1周内将丙戊酸镁加至0.6～0.8g/d,2次/d,口服。利培酮组予0.5mg/d,1次/d,口服。亦视病情情况在1周内将利培酮加至1～2mg/d,2次/d,口服。疗效评定采用CohanMansfield激越行为量表,临床总体疗效评定量表。安全性和药物不良反应评定采用药物副反应量表,于治疗开始前及治疗2,4,6,8周末各评定1次。以治疗前后CohanMansfield激越行为量表总分减分率为疗效指标标准,8周末减分率>50%为显效。以治疗末临床总体疗效评定量表等级变化分析治疗前后两组间的差异。血常规,尿常规,肝功能组合,心电图于实验开始前和治疗2,4,6,8周末各检查1次。结果:两组患者均完成治疗和量表评定,全部进入结果分析。①丙戊酸镁组总有效率65%,利培酮组总有效率68%,两组比较差异无显著性意义。②治疗后两组激越行为量表较治疗前有显著下降,至第8周末激越行为量表评分与治疗前比较差异有显著性意义(P<0.01),但治疗后两组激越行为量表评分差异无显著性意义(P>0.05)。丙戊酸镁组临床总体疗效评定量表由治疗前(5.27±0.93)分下降至(2.13±1.18)分,利培酮组由治疗前(5.26±0.89)分下降至(1.98±1.10)分,差异均有非常显著意义(P<0.01)。③丙戊酸镁组不良反应表现为恶心呕吐、食欲下降、嗜睡、头晕等。多在服药前2周出现,以后逐渐减轻。利培酮组不良反应表现为锥体外系副反应、食欲减退、口干、嗜睡、便秘等。两组不良反应发生率差异无显著性意义(25.58%,27.27%,P>0.05)。结论:丙戊酸镁和利培酮均能很好控制痴呆患者的激越行为,随着治疗的进展,丙戊酸镁不良反应越来越轻,较之利培酮有较好的依从性。
AIM： To observe the curative effect and safety of magnesium valproate and risperidone in the treatment of agitation behavior of gerontic dementia.
METHODS： A total of 87 inpatients with Alzheimer disease/vascular dementia （AD/VD） met Chinese classification of mental disorders （CCMD） -3 diagnostic criteria in Department of Gerontology, Second Affihated Hospital of Xinxiang Medical College were enrolled from December 2003 to December 2005. Two groups were divided by serial number, the odd numbers as the magnesium valproate group （n=43）, the even number cultivates the risperidone group （n=44） for the advantage. 0.2 g magnesium valproate was given in the magnesium valproate group daily, once a day, orally. 0.5 mg r isperidone was given in the risperidone group daily, once a day, orally. The dosage of magnesium valproate would reach to 0.6 to 0.8 g per day within one week, twice a day, orally, and that of risperidone would reach to 1 mg to 2 mg per day within one week, twice a day, orally. Cohan Mansfield agitated behavior checklist and Clinical Global Impression （CGI） were used to assess the curative effect. Treatment Emergent Symptom Scale （TESS） was applied to assess the safety and side effect of magnesium valproate and risperidone. Assessment was done once prior to the start of treatment and after treatment 2, 4, 6, 8 weeks, respectively. Reduction rate of total score of Cohan Mansfield agitated behavior checklist was considered as criterion of curative effect before and after treatment, and reduction rate at the end of week 8 was more than 50% as remarkable effect. The difference Of CGI in two groups was analyzed with the change of CGI class at the end of treatment. Blood routine, urine routine and hepatic function were examined once prior to the start of treatment anti after treatment 2, 4, 6, 8 weeks, respectively. RESULTS： The patients in the two groups had completed treatment and assessment, and involved in the result analysis. ①The total effective rate for the magnesium valproate and risperdal groups were 65% and 68%, respectively. The total effective rate of two groups had no significant differences. ②The score of Cohan Mansfield agitated behavior checklist had been reduced significantly as compared with before treatment. In the weekend of week 8 there was significant difference as compared with that before treatment （P 〈 0.01）. There was no significant difference after treatment （P 〉 0.05）. CGI score reduced from （5.27±0.93） points to （2.13±1.18） points in the magnesium valproate group. It decreased from （5.26±0.89） points to （1.98±1.10） points in the risperidone group. There was significant difference （P 〈 0.01）. ③Adverse effects of magnesium valproate group were vomiting, decreased food appetite, drowsiness, dizziness and so on, Mostly occurred at week 2 before drug administration, and then relieved gradually, The side effects in the risperidone group were EPS, decreased food appetite, dry mouth, drowsiness, constipation and so on. There was no significant difference between the two groups （25.58%, 27.27%, P 〉 0.05）.
CONCLUSION： Magnesium valproate and risperidone can effective control the agitation behavior of gerontic dementia. With the medical development, the side effect of magnesium valproate becomes light gradually, and has better compliance than risperidone.
出处
《中国临床康复》
CSCD
北大核心
2006年第30期158-159,共2页
Chinese Journal of Clinical Rehabilitation
