惊恐障碍在综合性医院识别现状和艾司西酞普兰治疗效果

Panic disorder identification in general hospital and curative effect of escitalopram

目的:探讨目前综合性医院临床各科室对惊恐障碍识别的临床分析和艾司西酞普兰在综合医院治疗惊恐障碍的有效性和安全性。方法:以胸闷、心慌、濒死感等不适主诉至我院就诊排除躯体疾病后转诊至医学心理科就诊268例患者,分析其中确诊为惊恐障碍的179例患者在临床各科室的首诊诊断构成,以及对其中168例惊恐障碍患者随机分为艾司西酞普兰组和帕罗西汀组,疗程8周,并用惊恐相关症状量表(PASS)、汉密尔顿焦虑量表(HAMA)、不良反应评定量表(SERS)对患者治疗前后进行评估。结果:确诊为惊恐障碍的179例患者在临床各科室的首诊诊断包括惊恐障碍、广泛性焦虑、抑郁症、心脏神经官能症、癔症、其他疾病等,首诊时诊断为惊恐障碍的患者仅占9.5%。患者在治疗1周、治疗2周艾司西酞普兰组的HAMA、PASS分值均低于对照组,而在治疗4、6、8周,两组患者的HA-MA、PASS分值差异无统计学意义(P>0.05)。在治疗8周时,艾司西酞普兰组治愈率为65.4%,有效率为91.4%,帕罗西汀组分别为63.7%,91.3%。两组差异无统计学意义。在不良反应方面,两组差异无统计学意义。结论:综合医院临床各科室对惊恐障碍患者首诊时的识别率较低。艾司西酞普兰治疗惊恐障碍疗效肯定,安全性较高。

Objective：To investigate panic disorder identification status in clinical divions of a general hospital,and to explore the efficacy and safety of escitalopram in treatment of panic disorder.Method：268 patients who saw a doctor for chest tightness,palpitation and inpending doom and were refered to the medical psychological department after excluding physical diseases were enrolled.179 patients were diagnosed as panic disorder and their first diagnosis were analysed.168 of 179 patients with panic disorder were randomly divided into two groups：study group were treated with escitalopram and the control group were treated with paroxetine.The treatment course was 8 weeks,all the subjects were rated by panic associated symptom scale（PASS）,Hamilton rating scale for anxiety（HAMA） and rating scale for side effects（SERS） at the baseline and the end of week 1,2,4,6,8,respectively.Results：The first diagnosison 179 patients in clinical divisions included panic disorder,generalized anxiety,depression,cordis neurosis,hysterical psychosis and other diseases.The first diagnosis rate of panic disorder is 9.5%.Scale of HAMA,PASS in the study group was significantly lower than that in the control group at the end of the first two weeks,but there were no significant differences between the two groups in both clinical effect and side effects at the end of week 4,6,8（P〉0.05）.The remission and response rates were 65.4% and 91.4% respectively in escitalopram group at the end of week 8 according to the HAMA score,while 63.7% and 91.3% respectively in paroxetine group,without statistical difference between the two groups.Conclusion：In general hospital clinical divisions,the first diagonsis correct rate of the panic disorder is very low,and panic disorder was easily misdiagnosed as other disease or disorder.Escitalopram is effective in treatment of patients with panic disorder and has better safety.