难治性精神分裂症氯氮平联合用药的德尔菲法调查

Delphi method investigation of clozapine combined therapy in treatment-resistant schizophrenia

目的:调查难治性精神分裂症(TRS)氯氮平联合用药的现状。方法:通过德尔菲法对南方4省8家精神专科医院进行3轮专家咨询,得出氯氮平单药治疗TRS疗效欠佳者(超难治性精神分裂症,STRs)的氯氮平联合用药治疗方案。结果:首轮调查在TRS定义等7个方面共22项意见中,有14项的认同率超过2/3,达成专家共识。获得了10种不同情况下联合用药选用顺序的推荐意见,有7项认同率超过2/3达成专家共识。第2轮调查中,从16种抗精神病药中推荐出氯氮平联合治疗STRs的3种抗精神病药(舒必利、利培酮、阿立哌唑),但没有具体推荐顺序。第3轮调查中,按疗效依次为阿立哌唑、利培酮、舒必利,按安全性分别为阿立哌唑、舒必利、利培酮。结论:氯氮平联用阿立哌唑治疗STRs有较好的疗效和安全性。

Objective:To investigate the current situation of clozapine combination in treatment-resistant schizophrenia(TRS).Method:Three rounds of expert consultation were conducted in eight psychiatric hospitals in four southern provinces through Delphi method,and the combined treatment scheme of clozapine was obtained in TRS patients with poor efficacy of clozapine(super treatment-resistant schizophrenia,STRs).Results:In the first round of survey,14 of the 22 opinions in 7 aspects such as TRS definition had a more than two-thirds comsistancy and reached expert consensus.The 10 recommendations on the selection order of combined drugs were obtained,and 7 of them were in agreement by more than two-thirds experts,reaching an expert consensus.In the second round of investigation,three antipsychotics(sulpiride,risperidone and aripiprazole)combined with clozapine for STRs were recommended from 16 antipsychotics,but there was no specific recommended order.Aripiprazole,risperidone,sulpiride were recommended according to the efficacy,and aripiprazole,sulpiride and risperidone were recommended according to the safety in the third round of investigation.Conclusion:Clozapine combined with aripiprazole is effective and safe in the treatment of STRs.