奥氮平换药治疗精神分裂症60例临床观察

clinical observations of Olanzapine replacement in treatment 60 paotients with schizophrenia

目的了解奥氮平治疗精神分裂症的疗效和安全性。方法同时符合CCMD-3精神分裂症诊断标准和连续30d以上使用其他药物并且疗效不佳或有严重副反应不能耐受需要换药治疗两项基本条件60例,停用已用抗精神病药物,改用奥氮平5～30mg/d,共治疗8周,以阳性和阴性症状量表((PANSS)评定临床疗效,以TESS和实验室监测评价安全性。结果60例患者中,基本痊愈14例(23.33%),显著进步22例(36.67%),好转15例(25.00%),无效9例(15.00%),总有效率率85.00%。不良反应:轻微震颤1例,白天思睡6例,口干2例,鼻塞1例,轻微恶心1例,均未处理。在用量超过20mg/d时出现静坐不能3例、窦性心动过速5例经普奈洛尔处理症状减轻。4周后体质量增加24例(40%),体质量增加2～7kg不等。结论奥氮平对阳性、阴性症状以及一般精神病症状均有良好疗效,常见副反应为胆碱能作用、嗜睡、体质量增加等。奥氮平是替代其他药物后,总体安全有效,患者的服药依从性好。

Objective To explore the effect and safety of Olanzapine treatment of schizophrenia. Methods The 60 Schizophrenic patiehts should accord with the diagnosis of CCMD-3 and with the other medication excluded Olanzapine for 30 days. Furthermore, the patients should have no severe side effects and not good effect needing replacement. So the patients＇ medication was replaced by Olanzapine 5 - 30 mg/day for 8 weeks. And then the patients were assessed with PANSS , TESS and labor tests. Results Among the 60 patients, almost recovery included 14 cases（23.33% ）, notably improvement was 22 cases（36. 67% ）, improvement was 15 cases（25.00% ）, inefficacy was 9 cases（ 15.00% ）, and the total efficacy rate was 85.00%. The side effect included 1 case of tiny tremor, 6 cases f day sleeping, 2 cases of dry mouth, and 1 case of snuffle and 1 case of tiny nausea, which were not dealt with. When the dosage exceeded 20 mg/day, 1 case of akathisia, 5 cases of sinus tachycardia appeared and all the symptoms were alleviated by using propanolol. After 4 weeks, 24 case appeared weight gaining （40%）, varying from 2 to 7 kilograms. Conclusions Olanzapine is good for positive, negative and general psychotic syndromes. The common side effects are cholinergic effects, lethargy and weight gaining and so on. Olanzapine is good for replacement to others, and has good safety and compliance.