盐酸哌甲酯控释片治疗儿童注意缺陷多动障碍疗效

Efficacy of Methylphenidate Hydrochloride controlled-release tablets on Attention-Deficit Hyperactivity Disorder in Children

目的：研究盐酸哌甲酯控释片治疗儿童注意缺陷多动障碍（ ADHD）的疗效。方法将72例ADHD患儿随机分成治疗组40例和对照组32例。治疗组给予盐酸哌甲酯控释片，初始剂量为每天0.5 mg·kg－1，根据患儿病情和耐受程度逐步增加至每天0.8~1.0 mg·kg－1，持续治疗3个月。对照组给予盐酸托莫西汀胶囊，初始剂量为每天0.5 mg·kg－1，根据患儿病情和耐受程度逐步增加至每天1.2~1.4 mg·kg－1，均于每日早餐后单次服药，疗程3个月。治疗前和治疗第12周进行韦氏智力测验、视听整合连续测试（IVA-CPT）、注意缺陷多动症状评估量表（SNAP-Ⅳ）和不良反应症状量表（TESS）评定。结果两组治疗后儿童注意缺陷及多动症状明显改善，韦氏智测评分明显增高（P〈0.05），SNAP-IV评分明显降低（P〈0.05），IVA-CPT评分明显提高（P〈0.05）。治疗组多动分数变化大于对照组（P〈0.05）；治疗组听觉注意、视觉注意变化得分大于对照组（ P〈0.05）；治疗组食欲下降10例，对照组14例。治疗组嗜睡1例，对照组5例（ P〈0.05）。治疗组入睡困难6例，对照组1例（ P〈0.05）。治疗组1例在治疗第4个月出现一过性抽动症状。结论盐酸哌甲酯控释片和盐酸托莫西汀均能快速有效改善儿童注意缺陷和多动症状，同时提高患儿的学习功能，而盐酸哌甲酯控释片改善速度更快。

Objective To observe the therapeutic effect of methylphenidate hydrochloride controlled-release tablets （OROS-MPH） on attention-deficit hyperactivity disorder （ADHD）. Methods Seventy-two cases of children with ADHD were randomly divided into treatment group （40） and control group （32）. Cases of treatment group were given 0.8-1.0 mg·kg-1 of OROS-MPH for three months. Cases of control group were given 1.2-1.4 mg·kg-1 of atomoxetine hydrochloride for three months. After 12 weeks treatment, children were evaluated by Wechsler intelligence test, Integrated visual and auditory continuous performance test （IVA-CPT）, the SNAP-Ⅳ effect assessment scale and TESS scale. Results The treatment efficiency was similar in both groups. Attention deficit and hyperactivity in both groups were improved obviously. Wechsler intelligence score was significantly elevated （ P〈0. 05）, SNAP-Ⅳ score was significantly decreased （ P〈0. 05）, and IVA-CPT score was increased significantly after treatment （ P〈0.05） . The changes of scores on hyperactivity, auditory attention and visual attention were more in OROS-MPH group than those in atomoxetine group（P〈0.05）. There was loss of appetite in 10 children of OROS-MPH group and in 14 children of atomoxetine group. There was drowsiness in 1 child of OROS-MPH group and in 5 children of atomoxetine group, as well as difficulty to fall asleep in 6 children of OROS-MPH group and 1 child of atomoxetine group （P〈0.05）. One child developed a transient spasm after 4-month treatment. Conclusion Both of OROS-MPH and atomoxetine hydrochloride can improve learning ability and the symptom of attention deficit and hyperactivity, and they are similarly effective and safe in children with ADHD, but OROS-MPH can work faster.