氯丙嗪静滴治疗精神分裂症患者激越症状的对照研究

The Effect of Intravenous Chlorpromazine on Agitation of Patients with Schizophrenia

目的探讨氯丙嗪静滴治疗精神分裂症患者激越症状的疗效、安全性及卫生经济学评价。方法 131例有激越症状的精神分裂症患者随机分为3组,分别接受氯丙嗪静滴（45例,剂量100~200mg/d）、氟哌啶醇肌注（44例,剂量10~30mg/d）、改良电痉挛治疗（42例,治疗8次）,疗程14d。于治疗前、治疗后3d、7d、14d,采用阳性和阴性症状量表（PANSS）总分及兴奋因子（PANSS-EC）条目分评价疗效;采用药物不良反应量表（TESS）、实验室检查评价安全性;采用人均直接医疗成本、成本-效果分析进行临床经济学分析。结果 1治疗后3d起,3组PANSS总分、PANSS-EC分即开始持续下降（t=2.710~3.735,P均〈0.01）;2治疗后14d,氯丙嗪组、MECT组的PANSS总分和PANSS-EC分下降率均高于氟哌啶醇组（t=2.093~2.234,P均〈0.05）;3氯丙嗪组、MECT组的有效率均高于氟哌啶醇组（分别χ2=4.212、5.385,P均〈0.05）;43组不良反应发生率无显著差异（P〉0.05）,氯丙嗪组、氟哌啶醇组TESS总分均高于MECT组（分别t=2.434、2.218,P均〈0.05）;5氯丙嗪组的临床经济学指标优于氟哌啶醇组,后者又优于MECT组。结论氯丙嗪静滴治疗精神分裂症患者激越症状疗效确切、安全性好、有卫生经济学的优势,可作为激越的备选治疗方案。

Objective To investigate the efficacy,safety and health economic evaluation of intravenous chlorpromazine treating agitation of patients with schizophrenia.Methods A total of 131 cases of schizophrenia with agitation were randomly divided into three groups,They were treated with intravenous chlorpromazine（45 patients,doses of 100~200mg/d）,haloperidol intramuscular injection（44 cases,doses of 10~30mg/d）,modified electroconvulsive therapy（42 patients,treatment 8）,treatment was14 d.Before treatment and 3d,7d,14d after treatment,using the Positive and Negative Syndrome Scale（PANSS） and the excitement factor（PANSS-EC） to evaluate efficacy;using treatment emergent symptoms scale（TESS） and laboratory tests to evaluate safety;using the per capita direct medical costs,cost-effectiveness analysis to evaluate the clinical economic.Results ①3d after treatment,PANSS＇ total score,PANSS-EC of three groups began to decrease（t=2.710~3.735,all P〈0.01）;② 14d after treatment,PANSS＇ total score and PANSS-EC of chlorpromazine group and MECT group were higher than those of the haloperidol group（t=2.093~2.234,all P〈0.05）;③Chlorpromazine group and MECT group＇s effective rate were higher than haloperidol group（χ2=4.212,5.385;both P〈0.05）;④The incidence of adverse reactions of 3 groups had no significant differences（P〈0.05）,TESS scores of chlorpromazine group and haloperidol group were higher than that of MECT group（t=2.434,2.218;both P〈0.05）.⑤The clinical-economic indicators of chlorpromazine group was better than haloperidol group,and haloperidol group was better than MECT group.Conclusion Intravenous chlorpromazine treating agitation of patients with schizophrenia is effective,safe and good,and has the advantage of health economics,can be used as the alternative treatment for agitation.