喹硫平联合碳酸锂治疗双相障碍躁狂发作的临床观察

Clinical Observation of Quetiapine Combined with Lithium Carbonate in the Treatment of Bipolar Disorder Manic Episode

目的：观察喹硫平联合碳酸锂治疗双相障碍躁狂发作的疗效和安全性。方法：110例双相障碍躁狂发作患者随机分为对照组（55例）和观察组（55例）。治疗前所有患者均停用原抗精神药物7 d。洗脱期后,对照组患者给予碳酸锂片,起始剂量0.25 g,饭后服用,每日2-3次,连用3 d,后加量至1-1.5 g,分2-3次,饭后服用。观察组患者在对照组治疗的基础上口服富马酸喹硫平片,第1天0.05 g,第2天0.1 g,第3天0.2 g,第4天0.3 g,均为每日2次,后改为0.4-0.6 g,分2-3次。两组疗程均为12周。观察两组患者的临床疗效、治疗前后躁狂量表（BRMS）评分、阳性和阴性症状量表（PANSS）评分、认知功能评分及不良反应发生情况。结果：观察组患者总有效率显著高于对照组,不良反应发生率显著低于对照组,差异均有统计学意义（P〈0.05）。治疗前,两组患者BRMS评分、PANSS评分、认知功能评分比较,差异均无统计学意义（P〉0.05）。治疗后,两组患者BRMS评分、PANSS评分均显著低于同组治疗前,且观察组低于对照组,认知功能评分显著高于同组治疗前,且观察组高于对照组,差异均有统计学意义（P〈0.05）。结论：喹硫平联合碳酸锂治疗双相障碍躁狂发作的疗效和安全性均优于单用碳酸锂,可显著改善患者的认知功能。

OBJECTIVE： To observe the efficacy and safety of quetiapine combined with lithium carbonate in the treatment of bipolar disorder manic episode. METHODS： 110 patients with bipolar disorder manic episode were randomly divided into control group （55 cases） and observation group （55 cases）. All patients stopped antipsychotics for 7 d. After the elution period, control group received Lithium carbonate tablet 0.25 g after a meal, twice-3 times a day, for 3 d, then increased to 1-1.5 g, for twice - 3 times, after a meal. Observation group was additionally given Quetiapine fumarate tablet 0.05 g in the first day, 0.1 g in the second day, 0.2 g in the third day, 0.3 g in the fourth day, twice a day, then changed to 0.4-0.6 g, for twice-3 times. The 2 groups were treated for 12 weeks. Clinical efficacy, mania scale （BRMS） score, positive and negative symptoms scale （PANSS） score, cogni- tive functions score before and after treatment, and the incidence of adverse reactions in 2 groups were observed. RESULTS： The total effective rate in observation group was significantly higher than control group, the incidence of adverse reactions was signifi- cantly lower than control group, with statistical significance （P〈0.05）. Before treatment, there were no significant differences in BRMS score, PANSS score and cognitive functions in 2 groups （P〉0.05）. After treatment, BRMS score and PANSS score in 2 groups were significantly lower than before, and observation group was lower than control group, cognitive fimctions were signifi- cantly higher than before, and observation group was higher than control group, with statistical significances （P〈0.05）. CONCLU- SIONS： Both efficacy and safety of quetiapine combined with lithium carbonate are superior to lithium carbonate alone in the treat- ment of bipolar disorder manic episode, and it can significantly improve patients＇ cognitive functions.