无抽搐电痉挛治疗难治性强迫症的对照研究

A comparative study of modified electroconvulsive therapy for refractory obsessive compulsive disorder

目的探讨无抽搐电痉挛治疗难治性强迫症的疗效及安全性。方法采用人院顺序分层随机法，将79例难治性强迫症患者随机分为研究组（无抽搐电痉挛治疗合并抗强迫药物）和对照组（抗强迫药物治疗），共观察4周，在治疗前及治疗第1周末、第2周末、第4周末采用Yale—Brown强迫量表、汉密尔顿焦虑量表、副反应量表评定疗效及不良反应。结果治疗第1周末，研究组Yale—Brown强迫量表[（22、47±3．09）分]及汉密尔顿焦虑量表评分[（19．59±3．51）分]较治疗前[分别为（27．07±1．34）分、（24、99±3．76）分]均有显著性降低（t=6．10，7．69，P〈0．05），而对照组均无显著性改善（t=1．32，1．78，P〉0、05）。治疗第1周末、第2周末及第4周末，研究组的Yale—Brown强迫量表[分别为（22．47±3．09）分、（14．93±2、92）分、（10、93±4．23）分]及汉密尔顿焦虑量表评分[分别为（19．59±3．51）分、（16．60±2．97）分、（11．40±2．68）分]均显著低于对照组的Yale—Brown强迫量表[分别为（26．33±4．49）分、（21．40±3．58）分、（19．60±4．26）分]及汉密尔顿焦虑量表评分[分别为（24、38±3．34）分、（20．78±4．05）分、（19．79±3．08）分]，均差异有显著性（t=4．36，21．30，P〈0．05）。在治疗第1周末、第2周末及第4周末，研究组[分别为35．90％、58．97％、74．36％]和对照组[分别为0．00％、17．50％、32．50％]的治疗有效率差异有显著性（X^2=13．90～14．42，P〈0．05）。研究组未出现严重不良反应。结论无抽搐电痉挛治疗是治疗难治性强迫症快速、有效、安全的首选方法之一。

Objective To explore the efficacy and side effects of modified electroconvulsive therapy （MECT） in treatment of refractory obsessive compulsive disorder. Methods A total of 79 patients with refractory obsessive compulsive disorder were randomly divided into study group with MECT and control group with antide- pressants for treatment of 4 weeks. They were assessed and analysed eontrastively using Yale-Brown Obsessive Compulsive Scale （YBOCS）, Hamilton Axiety Scale （HAMA） and Treatment Emergent Side Effect Scale （TESS）. Results In the 1st weekend,the total scores of YBOCS （22.47±3.09）and HAMA （19.59 ±3.51）in study group were significantly decreased than those before treatment （ as follows ： 27.07 ± 1.34,24.99 -± 3.76） （ t = 6.10 - 7.69, P 〈 0.05 ） and there was no difference in control group （ t = 1.32 - 1.78, P 〉 0.05 ）. In the 1 st,2nd and 4th weekend, the total scores of YBOCS （ as follows ： 22.47 ± 3.09,14.93 -± 2.92,10.93 ± 4.23 ） and HAMA （ as follows ： 19.59 -± 3.51,16.60 -± 2.97,11.40 ± 2.68 ） in study group were significantly lower than the total scores of YBOCS （ as follows ： 26.33 ± 4.49,21.40 ± 3.58,19.60 ± 4.26 ） and HAMA （ as follows ： 24.38 ± 3.34,20.78 ± 4.05,19.79 ± 3.08 ） in control group（ t = 4.36 - 21.30, P 〈 0.05 ）. In the 1 st ,2nd and 4th weekend,the effective rates had significant differences between study group （as follows： 35.90,58.97,74.36% ） and control group（ as follows： 0.00% , 17.50,32.50% ） （ X^2 = 13.90 - 14.42, P 〈 0.05 ）. No severe side effect was found in study group. Condusion MECT is effective in treating refractory obsessive compulsive disorder without severe side effects.