齐拉西酮序贯治疗精神分裂症患者的影响因素分析

Analysis of influencing factors on schizophrenia patients with sequential therapy of ziprasidone

目的观察应用甲磺酸齐拉西酮针剂治疗后进行序贯口服剂型治疗精神分裂症患者的疗效及其影响因素,为合理应用序贯治疗方案提供临床依据。方法参照《精神障碍诊断与统计手册(第4版)》(DSM-Ⅳ),应用阳性和阴性症状量表(PANSS)评定40例以兴奋激越症状为主的精神分裂症患者的精神症状。在治疗前(基线期)对患者一般状况进行问卷调查。在甲磺酸齐拉西酮针剂肌注治疗72小时后进行口服序贯治疗,在基线期和肌注治疗72小时后进行PANSS评定,采用副反应量表(TESS)评定不良反应,分析疗效及其影响因素。结果 24例患者成功序贯;16例患者因为疗效和耐受性问题序贯治疗效果不好,其中7例换用其他第二代非经典抗精神病药物;9例第二次应用齐拉西酮针剂治疗3天,再次序贯为口服剂型,5例序贯成功,4例换用其他第二代非经典抗精神病药物治疗。结论对第一次序贯治疗不成功的患者可以选择第二次注射治疗,第二次序贯后有部分患者成功。序贯治疗的效果和患者是否首发、体重水平、饮酒习惯有关,还与注射之外的治疗因素,如医生护士和患者的交流、治疗同盟关系建立的质量有关。

Objective To observe curative effect of applying sequential therapy of oral dosage forms after the aiprasidone mesylate injection treatment for people with schiaophreniaand and analysis the influencing factors for providing clinical basis in reasonable application of sequential treatment. Methods Totally 40 patients with schiaophrenia according to the Diagnostic and Statistical Manual of Mental Disorders Fourth edition（DSM - IV）who mainly showed symptoms of excitation and agitation were evaluated using Positive and Negative Syndrome Scale（PANSS）. General situation questionnaire was used to investigate patients before treatment（baseline）.After 72 hours of aiprasidone mesylate injection treatment,sequential therapy was conducted with oral aiprasidone. Patients were assess ed using PANSS at baseline and 72 hours after treatment of intramuscular injection. Side effects were assessed with Treatment Emergent Symptom Scale（TESS）. Results 24 patients were succeeded in the sequential treatment. There were 16 patients whose therapeutic effect were poor because of the efficacy and tolerance of treatment,in which 7 patients’treatment were changed with another second generation of atypical antipsychotics. Second sequential therapy were applied to another 9 patients after 3 days therapy of aiprasidone mesylate for injection,in which 5 patients were succeeded and 4 patients’treatments were replaced with another second generation of atypical antipsychotics. Conclusion The second injection treatment can be applied to the patients who were not succeed in the first sequential therapy and some patients were succeeded in the second sequential therapy. The efficacy of sequential therapy is associated with patients’weight,drinking habits and whether first - episode. It is also related to other factor except injection factors,such as the relationship between patients and doctors,quality of the therapeutic alliance.