盐酸哌甲酯控释剂治疗儿童注意缺陷多动障碍的疗效

Clinical Effect of Control-Released Methylphenidate Hydrochloride on Attention-Deficient Hyperactivity Di-sorder in Children

目的观察中枢神经兴奋剂盐酸哌甲酯控释片对儿童注意缺陷多动障碍(ADHD)的临床疗效。方法 2005年6月-2008年12月在本科儿童多动症门诊就诊的ADHD患儿113例。男87例,女26例;年龄(8.1±2.7)岁,其中盐酸哌甲酯控释片治疗组(控释组)86例,速释哌甲酯片治疗组(速释组)27例。分别观察用药后2周及6个月患儿注意力和行为改善情况,以及用药的依从性。分别于治疗前、治疗1个月和6个月随访时对患儿进行视听连续整合测试(IVA-CPT)、Conner′s儿童行为量表、韦氏智力量表进行疗效评价。结果控释组和速释组用药2周内注意力和行为改善分别为91.9%、88.9%,6个月注意力和行为改善分别为96.5%、59.3%;控释组的依从性显著高于速释组。2组治疗1个月综合反应控制商数(FRCQ)、综合注意力商数(FAQ)较治疗前均明显改善(Pa<0.01),控释组6个月随访时FRCQ和FAQ仍保持较高水平。2组治疗1个月Conner′s儿童行为量表6个因子得分较治疗前均明显降低(Pa<0.01),控释组治疗6个月6个因子得分均显著低于速释组(Pa<0.05)。2组治疗6个月韦氏智力评定全量表IQ、言语量表IQ、操作量表IQ均明显上升(Pa<0.01)。2组不良反应均较轻微。结论哌甲酯控释治疗可有效改善ADHD核心症状,长期提高患儿的认知功能和注意力,依从性显著高于速释哌甲酯治疗,药物不良反应轻微。

Objective To observe the clinical effect of methylphenidate hydrochloride control-released tablets as central nervous system stimulant on attention-deficient hyperactivity disorder（ADHD） in children.MethodsThe 113 children with ADHD in our outpatients department,87 male and 26 female of the total,and the mean age（8.1±2.7） years old were divided into 2 groups：86 cases in control-released methylphenidate treatment group（control-released group） and 27 cases in immediate-released methylphenidate treatment group（immediate-released group）.Then followed-up for 6 months,to observe the effect of attention and behavior improvement,and drug compliance in 2 weeks and 6 month followed-up,respectively.The effectiveness was evaluated before treatment,1 month after treatment and 6 months followed-up with integrated visual and auditory continuous performance test（IVA-CPT）,Conner′s behavior rating scale and Wechsler intelligence scale.ResultsAttention and behavior improvement to 91.9%,88.9% within 2 weeks,and 96.5%,59.3% in 6 months followed-up control-released group and immediate-released group,respectively.The drug compliance in control-released group higher than that in immediate-released group.Both full response control quotient（FRCQ）and full attention quotient（FAQ） in 1 month after treatment were significantly improved compare with before treatment in 2 groups（Pa0.01）,and both FRCQ and FAQ remaining high in 6 months followed-up in control-released group.Six quotient scales of Conner′s behavior rating scale in 1 month after treatment was significantly decreased compare with before treatment in 2 groups（Pa0.01）,and 6 quotient scales of Conner′s behavior rating scale in control-released group were significantly lower than those in immediate-released group in 6 months followed-up（Pa0.05）.The full intelligence quotient,verbal intelligence quotient and performance intelligence quotient of Wechsler intelligence scale in 6 months followed-up were significantly elevated compared with before treatment in 2 groups（Pa0.01）.There were no significant difference between 2 groups in the little adverse reaction.ConclusionsThe control-released methylphenidate hydrochloride has the effect of reducing the core symptoms of ADHD,to enhance the cognitive ability and attention of ADHD for long time,and there were more clinical compliance and less adverse reaction than immediate-released methylphenidate.J Appl Clin Pediatr,2011,26（6）： 452-454