盐酸哌甲酯联合心智化家庭治疗对注意缺陷多动障碍患儿临床疗效和社会功能的影响

Effect of methylphenidate hydrochloride combined with mentalization-based family therapy on clinical efficacy and social function in children with attention deficit hyperactivity disorder

目的观察盐酸哌甲酯(methylphenidate hydrochloride, MPH)缓释片联合心智化家庭治疗(mentalization-based family therapy, MBFT)对注意缺陷多动障碍(attention deficit hyperactivity disorder, ADHD)儿童的临床疗效和社会功能的影响。方法选取2019年6月至2021年5月在无锡儿童医院、江南大学附属医院确诊的64例ADHD患儿, 根据随机数字表法分为观察组(n=32)和对照组(n=32), 两组患儿均接受MPH缓释片治疗, 观察组患儿在MPH治疗基础上接受MBFT, 疗程均为12周。采用Conners家长用表评分(parent symptom questionnaire, PSQ)、斯诺佩评定量表(Swanson Nolan and Pelham-version Ⅳ, SNAP-Ⅳ)父母版评分和Weiss功能缺陷家长用表(Weiss functional impairment scale-parent form, WFIRS-P)评估两组患儿疗效。采用SPSS 25.0进行统计分析。计数资料使用χ^(2)检验, 计量资料两组治疗前后评分比较使用配对样本t检验。结果 (1)观察组和对照组患者PSQ各维度评分均较治疗前显著降低(均P<0.01), 与治疗后对照组比较, 治疗后观察组PSQ维度中品行问题[(1.25±0.15)分, (0.94±0.18)分;t=7.484, P<0.001]、学习问题[(1.57±0.16)分, (1.32±0.20)分;t=5.522, P<0.001]、心身障碍[(0.56±0.11) 分, (0.44±0.13) 分;t=3.986, P<0.001]、冲动-多动[(1.76±0.23)分, (1.54±0.25) 分;t=3.663, P<0.001]、焦虑[(0.94±0.12) 分, (0.76±0.11) 分;t=6.255, P<0.001]、多动指数[(1.74±0.19), (1.51±0.16);t=5.238, P<0.001]的评分显著降低。(2)与治疗前相比, 治疗后两组患儿SNAP-Ⅳ量表中注意力缺陷、冲动-多动和对立违抗3个维度评分均显著降低(均P<0.01);并且与对照组比较, 观察组SNAP-Ⅳ量表上述3个维度评分均显著降低(均P<0.01)。(3)观察组患儿WFIRS-P量表中家庭、学习和学校、生活技能、自我管理、社会活动以及冒险活动6个维度评分均在治疗后较治疗前显著降低(均P<0.01), 并且观察组WFIRS-P量表上述6个维度评分均较对照组显著降低(均P<0.01)。结论盐酸哌甲酯缓释片联合MBFT可显著改善ADHD患儿的临床症状和社会功能。

Objective To observe the effect of methylphenidate hydrochloride(MPH)combined with mentalization-based family therapy(MBFT)on clinical efficacy and social function in children with attention deficit hyperactivity disorder(ADHD).Methods Sixty-four children with ADHD diagnosed in Wuxi Children's Hospital and Affiliated Hospital of Jiangnan University from June 2019 to May 2021 were selected and divided into observation group(n=32)and control group(n=32)according to the random number table.Children in both groups received methylphenidate hydrochloride extended-release tablets,while those in the observation group were given additional MBFT.The duration of treatment was 12 weeks in both groups.The parent symptom questionnaire(PSQ),swanson nolan and pelham-versionⅣ(SNAP-Ⅳ)parent Al scale,and Weiss impairment functional scale(WFIRS-P)were used to evaluate the effectiveness of treatment.Statistical analysis was performed by SPSS 25.0 statistical software.In particular,theχ^(2) test was used for counting data and the paired sample t test was used for comparison of measurement data between the two groups before and after treatment.Results(1)All the PSQ dimension scores of patients in the observation group and the control group after treatment were significantly lower than those before treatment(all P<0.01).Compared with the control group after treatment,the PSQ dimension scores of personality and behavior problems((1.25±0.15),(0.94±0.18),t=7.484,P<0.001),learning problems((1.57±0.16),(1.32±0.20),t=5.522,P<0.001),psychosomatic disorders((0.56±0.11),(0.44±0.13),t=3.986,P<0.001),impulse hyperactivity((1.76±0.23),(1.54±0.25),t=3.663,P<0.001),anxiety((0.94±0.12),(0.76±0.11),t=6.255,P<0.001)and hyperactivity index((1.74±0.19),(1.51±0.16),t=5.238,P<0.001)decreased significantly in the observation group after treatment.(2)Compared with the pre-treatment period,the SNAP-Ⅳscale scores of attention deficit,impulsivity-hyperactivity and oppositional defiance were significantly lower in both groups after treatment(all P<0.01);and compared with the control group,the SNAP-Ⅳscale scores of the above three dimensions were significantly lower in the observation group(all P<0.01).(3)All six dimensions(family,learning and school,life skills,self-management,social activities,and risk-taking activities)of the WFIRS-P scale were significantly lower in the children in the observation group after treatment compared with those before treatment(all P<0.01),and all the six dimensions of the WFIRS-P scale were significantly lower in the observation group compared with those in the control group(all P<0.01).Conclusion Methylphenidate hydrochloride extended-release tablets combined with MBFT can significantly improve the clinical symptoms and social function of children with ADHD.