盐酸哌甲酯缓释片对注意缺陷多动障碍患儿认知加工过程的影响

Influence of Methylphenidate Hydrochloride prolonged - release tablets on the cognitive processing of children with attention deficit hyperactivity disorder

目的探究盐酸哌甲酯缓释片治疗对注意缺陷多动障碍（ADHD）患儿认知加工过程的影响。方法选取接受盐酸哌甲酯缓释片治疗（28±3）d的30例ADHD患儿为ADHD组，同时选取30例健康儿童为健康对照组，采用Das—Nagliefi认知评估系统（DN：CAS）对ADHD组在治疗前、治疗后及健康对照组儿童进行大脑认知加工过程测验，比较ADHD组在治疗前及治疗后与健康对照组认知加工过程的差异，同时比较ADHD组在治疗前后认知加工过程的差异。结果与健康对照组比较，ADHD组治疗前DN：CAS测验中的计划分测验[（21．86±4．61）分比（29．33±5．06）分]、注意分测验[（25．00±4．57）分比（29．83±3．79）分]及总分[（111．93±13．95）分比（127．26±15．53）分]的量表分降低，差异均有统计学意义（t=-5．976、-4．455、-4．023，均P〈0．05）；数字匹配、计划编码、计划链接、表达性注意、数字检测、接受性注意6个小测验量表分均降低，差异均有统计学意义（t=-4．787、-3．703、-4．991、-2．216、-2．488、-3．219，均P〈0．05）。ADHD组治疗后DN：CAS测验中的计划分测验量表分仍低于健康对照组[（25．53±4．98）分比（29．33±5．06）分]，差异有统计学意义（t=-2．931，P〈0．05），数字匹配、计划编码2个小测验量表分仍低于健康对照组，差异均有统计学意义（t=-2．654、-2．044，均P〈0．05）。ADHD组治疗后DN：CAS测验中的计划分测验[（25．53±4．98）分比（21．86±4．61）分]、同时性加工分测验[（36．10±7．10）分比（34．13±6．04）分]、注意分测验[（27．90±5．69）分比（25．00±4．57）分]及总分[（121．50±16．55）分比（111．93±13．95）分]均高于治疗前，差异均有统计学意义（t=-5．679、-2．949、-3．869、-5．963，均P〈0．05）；数字匹配、计划编码、计划链接、非言语矩阵、数字检测、接受性注意、言语速率／句子提问7个小测验量表分均高于治疗前，差异均有统计学意义（t=-2．528、-3．209、-3．890、-2．276、-4．489、-2．208、-2．373，均P〈0．05）。结论盐酸哌甲酯缓释片可以提高ADHD儿童认知加工过程的能力，以注意功能提高更为显著。

Objective To explore the influence of Methylphenidate Hydrochloride prolonged - release tablets on the cognitive processing of children with attention deficit hyperactivity disorder （ADHD）. Methods Thirty ADHD children and 30 healthy controls were enrolled in this study, and the ADHD subjects were treated with Methylphenidate Hydrochloride prolonged - release tablets for （ 28 ± 3） days. Pre - test and post - test by the Das - Naglieri ： Cognitive Assessment System（ DN ：CAS） were done to evaluate the cognitive function of all individuals. The differences of cogni- tive processing in pre - treatment and post - treatment of ADHD group with healthy control group were compared. The difference between before and after treatment of ADHD was also compared. Results Compared with healthy control group,there were lower of planning score [ （21. 86 ± 4.61 ） scores vs. （29.33 ± 5.06） scores], attention score [ （25.00 ± 4.57 ） scores vs. （ 29.83 ＋ 3.79） scores ], and the total scores [ （ 111.93 ± 13.95 ） scores vs. （ 127.26 ± 15.53） scores [ in ADHD group, and there were significant differences （ t = - 5. 976, - 4. 455, - 4. 023, all P 〈 0.05 ）. The matching number, planned codes, planned connections, expressive attention, number detection and receptive attention scores were also lower in ADHD group, and there were significant differences （t = -4. 787, -3. 703, - 4. 991, - 2. 216, - 2. 488, - 3. 219, all P 〈 0.05）. Compared with healthy control group, there were lower of plan- ning score with significant difference [ （ 25.53 ± 4.98 ） scores vs. （ 29.33 ± 5.06 ） scores, t = - 2.931, P 〈 0.05 ] in ADHD group after treatment, matching number and planned codes were lower with significant difference （ t = - 2. 654, - 2. 044, all P 〈 0.05 ） in ADHD group after treatment. In ADHD group, the scores of planning [ （ 25.53 ± 4.98 ） scores vs. （21.86 ＋ 4.61 ） scores ], simultaneous processing [ （ 56.10 ± 7. 10 ） scores vs. （34.13 ± 6.04 ） scores ], attention [ （27.90 ± 5.69） scores vs. （25.00 ± 4.57） scores ] and the total score [ （ 121.50 ±16.55 ） scores vs.（ 111.93 ± 13.95 ） scores ] were significantly higher after treatment than that before treatment and there were significant differences （ t = - 5. 679, - 2. 949, - 3. 869, - 5. 963, all P 〈 0. 05 ） ; matching number, planned codes, planned con- nections, nonverbal matrices, number detection, receptive attention and word series were significantly higher after treat- ment than that before treatment, and there were significant differences （ t = - 2. 528, - 3. 209, - 3. 890, - 2. 276, - 4.489, - 2.208, - 2.373, all P 〈 0.05）. Conclusion The Methylphenidate Hydrochloride prolonged - release tab- lets can improve the function of cognitive processing in children with ADHD, especially in attention.