精苓合剂联合哌甲酯治疗儿童注意缺陷多动障碍的疗效观察

Clinical observation of Jingling Mixture combined with methylphenidate in treatment of attention deficit hyperactivity disorder in children

目的探讨精苓合剂联合哌甲酯治疗儿童注意缺陷多动障碍的临床疗效。方法选取2020年1月—2022年12月苏州市立医院北区门诊诊治的88例注意缺陷多动障碍患儿,按随机数字表法将所有患者分为对照组和治疗组,每组各44例。对照组口服盐酸哌甲酯缓释片,初始剂量18 mg/次,疗效欠佳者增加剂量18 mg至每日剂量36 mg,1次/d,温开水整片送服。治疗组在对照组治疗基础上口服精苓合剂,6岁<患儿≤9岁,6~9 mL/次;9岁<患儿≤12岁,10 mL/次;均为2次/d。两组疗程均为12周。观察两组的临床疗效,比较两组核心症状好转时间及治疗前后Swanson,Nolan and Pelham父母评定量表(SNAP)-Ⅳ、Conners父母症状问卷(PSQ)、儿童困难问卷(QCD)、Weiss功能缺陷量表(父母版)(WFIRS-P)、长处和困难问卷(SDQ)、Achenbach儿童行为量表(CBCL)评分。结果治疗后,治疗组总有效率是95.45%,较对照组的81.82%显著提高(P<0.05)。治疗后,治疗组多动、注意缺陷、冲动的好转时间均显著短于对照组(P<0.05)。治疗后,两组注意缺陷评分、多动-冲动评分、对立违抗评分和总分均较治疗前显著降低(P<0.05);且治疗后,治疗组SNAP-Ⅳ各评分显著低于对照组(P<0.05)。治疗后,两组PSQ、WFIRS-P、SDQ、CBCL评分均显著降低,而QCD评分则显著增加(P<0.05);治疗后,治疗组PSQ、WFIRS-P、SDQ、CBCL、QCD评分改善优于对照组(P<0.05)。结论精苓合剂联合哌甲酯治疗儿童注意缺陷多动障碍总体疗效确切,能有效加快患儿核心症状好转,减轻功能损害及情绪和行为问题,值得临床推广应用。

Objective To investigate the clinical efficacy of Jingling Mixture combined with methylphenidate in treatment of attention deficit hyperactivity disorder in children.Methods A total of 88 children with attention deficit hyperactivity disorder diagnosed and treated in North District of Suzhou Municipal Hospital from January 2020 to December 2022 were selected,and all patients were divided into control group and treatment group according to random number table method,with 44 cases in each group.Children in the control group were po administered with Methylphenidate Hydrochloride Prolonged-Release Tablets,and the initial dosage was 18 mg/time,and if the efficacy was not good,the dosage was increased by 18 mg to 36 mg daily,once daily,and the whole tablet was taken with warm water.Patients in the treatment group were po administered with Jingling Mixture on the basis of the control group,6 years old<children≤9 years old,6—9 mL/time;9 years old<children≤12 years old,10 mL/time,twice daily.The treatment course of both groups was 12 weeks.The efficacy of two groups was observed.The improvement time of core symptoms was compared between two groups.And Swanson before and after treatment,Nolan and Pelham Parent Rating Scale(SNAP)-Ⅳ,Conners Parent Symptom Questionnaire(PSQ),Child Difficulty Questionnaire(QCD),Weiss Functional Impairment Scale(Parent version)(WFIRS-P),Strengths and Difficulties Questionnaire(SDQ),Achenbach Child Behavior Scale(CBCL)scores before and after treatment were compared between two groups.Results After treatment,the total effective rate of treatment group was 95.45%,which was significantly higher than that of control group(81.82%)(P<0.05).After treatment,the improvement time of hyperactivity,attention deficit and impulsivity in the treatment group was significantly shorter than that in control group(P<0.05).After treatment,attention deficit score,hyperactivity-impulse score,oppositional defiant score and total score were significantly decreased in both groups compared with before treatment(P<0.05).After treatment,SNAP-Ⅳscores in treatment group were significantly lower than those in control group(P<0.05).After treatment,PSQ,WFIRS-P,SDQ and CBCL scores were significantly decreased,but QCD scores were significantly increased in both groups(P<0.05).After treatment,the scores of PSQ,WFIRS-P,SDQ,CBCL and QCD in treatment group were better than those in control group(P<0.05).Conclusion Jingling Mixture combined with methylphenidate has accurate overall effect in treatment of attention deficit hyperactivity disorder in children,and can effectively accelerate the improvement of core symptoms,reduce functional impairment,emotional and behavioral problems,which is worthy of clinical application.