丙戊酸钠联合氯氮平治疗难治性精神分裂症患者临床研究

Clinical study of sodium valproate combined with clozapine in treatment of patients with refractory schizophrenia

目的:分析丙戊酸钠联合氯氮平治疗难治性精神分裂症(TRS)患者的效果。方法:选取本院2020年1月—2023年6月收治的TRS患者共60例,按随机数字表法分为两组,各30例。对照组予以氯氮平治疗(口服,初始用量为25 mg/次,3次/d,1周后逐渐增加用量,一般用量为200~300 mg/d,持续用药3个月),观察组加以丙戊酸钠治疗(对照组基础上口服丙戊酸钠,250 mg/次,2次/d,连续治疗3个月)。比较两组治疗效果。结果:观察组治疗总有效率高于对照组,有统计学差异(P<0.05)。治疗前,两组阳性与阴性症状量表(PANSS)内各维度评分、可重复成套神经心理状态测验量表(RBANS)评分及多导睡眠监测(PSG)监测结果比较无统计学差异(P>0.05);治疗后,观察组PANSS内各维度评分低于对照组;且治疗后的SE和RBANS评分高于对照组,TST、REM时间和S2时间长于对照组,觉醒时间和S1时间短于对照组,有统计学差异(P<0.05)。两组不良反应比较无统计学差异(P>0.05)。结论:丙戊酸钠联合氯氮平可减轻TRS患者精神症状,恢复认知功能,改善睡眠质量,且不会增加不良反应。

Objective:To analyze the efficacy of sodium valproate combined with clozapine in the treatment of refractory schizophrenia(TRS).Methods:Sixty total with 60 TRS patients admitted to the our hospital between January 2020 and June 2023 were selected and divided into two groups according to the random number table method,with 30 cases in each group.The control group was orally administered clozapine(The initial dosage was 25 mg/time,3 times/day.After one week,the dosage was gradually increased to 200~300 mg/day for continuous three months).The observation group was treated with sodium valproate(in addition to the control group,the control group received oral sodium valproate at a dose of 250 mg twice a day for three consecutive months).Therapeutic effects in the two groups were compared.Results:The total effective rate in the observation group was significantly higher than that in the control group(P<0.05).Before treatment,there was no significant difference(P>0.05)in the scores of various dimensions within the Positive and Negative Symptom Scale(PANSS),Repeatable Set of Neuropsychiatric State Test(RBANS)scores,and polysomnography(PSG)monitoring between the two groups.After treatment,the PANSS scores of various dimensions in the observation group were lower than those in the control group.The SE and RBANS scores after treatment were higher than those in the control group,with TST,REM time,and S2 time longer than those in the control group,and awakening time and S1 time shorter than those in the control group(P<0.05).There were no statistically significant differences in adverse reactions between the two groups(P>0.05).Conclusion:Sodium valproate combined with clozapine alleviated psychiatric symptoms,restored cognitive function,improved sleep quality,and did not increase adverse reactions in TRS patients.