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奥氮平联合重复经颅磁刺激治疗以幻听为主的精神分裂症疗效观察

Effect of olanzapine combined with repetitive transcranial magnetic stimulation in the treatment of schizophrenia with auditory hallucination

摘要:

目的 探讨奥氮平联合重复经颅磁刺激( rTMS)治疗以幻听为主的精神分裂症的临床疗效.方法 选择宁波市康宁医院2015年8月至2016年11月治疗的以幻听为主的精神分裂症患者112例为研究对象,依照治疗方案不同分成观察组56例、对照组56例,观察组采用奥氮平联合rTMS治疗,对照组单用奥氮平治疗,观察两组治疗前后阳性及阴性症状量表(PANSS)评分、威斯康星卡片分类测验( WCST)评分,比较两组临床疗效.结果 治疗前,两组PANSS评分、WCST评分差异均无统计学意义(均P>0.05).治疗后1周、2周、4周,两组PANSS评分比治疗前均显著下降( F=170.710、106.028、28.530、30.328、25.806、10.832、203.342、372.253,均P<0.05),观察组PANSS评分下降更加明显;观察组治疗1周、2周、4周阳性症状评分分别为(25.95 ±3.50)分、(24.72 ±4.50)分、(16.51 ±2.70)分,均显著低于对照组的(27.27 ±2.03)分、(27.80 ±5.37)分、(19.53 ±3.07)分(t=2.441、3.290、5.528,均P<0.05).观察组治疗后1周、2周、4周持续反应数分[(45.62 ±5.41 )分、 (44.69 ±4.91)分、( 35.89 ±3.30)分]较对照组[(50.61 ±5.35)分、(46.80 ±5.14)分、(42.70 ±5.04)分]均显著较低(t=4.908、2.221、8.459,均P<0.05),持续错误数评分[(49.47 ±4.59)分、(46.53 ±6.05)分、(36.35 ±5.18)分]较对照组[(83.1 ±6.58)分、(81.85 ±6.70)分、(76.86 ±5.94)分]均低(t=31.369、29.279、38.464,均P<0.05);治疗后1周、2周完成分类数评分[(4.21 ± 2.03)分、(5.35 ±2.23)分]较对照组[(3.35 ±1.24)分、(3.95 ±1.24)分]均高(t=2.705、4.106,均P<0.05).观察组有效率为91.0%,对照组为89.2%,两组差异无统计学意义(χ2=0.022,P>0.05).结论 奥氮平联合rTMS治疗以幻听为主的精神分裂症的临床疗效较单一使用奥氮平更佳,且奥氮平联合rTMS在改善患者认知能力方面效果更显著.

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abstracts:

Objective To study the effect of olanzapine combined with repetitive transcranial magnetic stimulation(rTMS) in the treatment of phonism dominated schizophrenia.Methods From August 2015 to November 2016,112 patients with phonism based schizophrenia in Ningbo Kangning Hospital were selected in the research . According to the different treatment ,the patients were divided into observation group and control group ,with 56 cases in each group.The observation group was treated with olanzapine combined with rTMS chemotherapy ,the control group was treated with olanzapine.Before and after treatment,the positive and negative symptom scale ( PANSS) score, Wisconsin Card Sorting Test ( WCST) score of the two groups were observed.The clinical efficacy was compared between the two groups.Results Before treatment,there were no statistically significant differences in PANSS score and WCST score between the two groups ( all P>0.05).After treatment for 1 week,2 weeks,4 weeks,the PANSS scores of the two groups were significantly lower than those before treatment (F=170.710,106.028,28.530,30.328, 25.806,10.832,203.342,372.253,all P<0.05).The PANSS scores decreased more significantly in the observation group.After treatment for 1,2,4 weeks,the scores of positive symptoms in the observation group were (25.95 ±3.50)points, (24.72 ±4.50)points and(16.51 ±2.70)points,respectively,which were significantly lower than those in the control group[(27.27 ±2.03)points,(27.80 ±5.37)points,(19.53 ±3.07)points](t=2.441,3.290,5.528,all P<0.05).After treatment for 1 week,2 weeks,4 weeks,the continuous response scores in the observation group were (45.62 ±5.41)points,(44.69 ±4.91) points,(35.89 ±3.30) points,respectively,which were significantly lower than those in the control group[(50.61 ±5.35)points,(46.80 ±5.14)points,(42.70 ±5.04)points](t=4.908, 2.221,8.459,all P<0.05).The scores of continuous errors in the observation group were (49.47 ±4.59) points, (46.53 ±6.05) points and (36.35 ±5.18) points,respectively,which were lower than those in the control group [(83.1 ±6.58)points,(81.85 ±6.70)points and (76.86 ±76.86)points](t=31.369,29.279,38.464,all P<0.05).After treatment for 1 week,2 weeks,the classification scores in the observation group were (4.21 ±2.03) points and (5.35 ±2.23) points,respectively,which were significantly higher than those in the control group [(3.35 ±1.24)points and (3.95 ±1.24)points] (t=2.705,4.106,all P<0.05).The effective rate was 91.0%in the observation group ,which was 89.2%in the control group,there was no statistically significant difference (χ2=0.022,P>0.05).Conclusion Olanzapine combined with rTMS is effective in the treatment of schizophrenia ,and olanzapine combined with rTMS is more effective in improving the cognitive ability of patients than olanzapine alone .

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作者: 徐永明 [1] 黎兴兴 [1] 周琪 [1] 庄文豪 [1] 刘灵江 [1] 方泽忠 [1] 周东升 [1]
期刊: 《中国基层医药》2018年25卷23期 3059-3063页 ISTIC
栏目名称: 论著
DOI: 10.3760/cma.j.issn.1008-6706.2018.23.018
发布时间: 2019-01-09
基金项目:
浙江省宁波市科技计划项目 浙江省宁波市医学科技计划项目(2016A07) Zhejiang Ningbo Science and Technology Plan Project Medical Science and Technology Project Project of Ningbo City ,Zhejiang
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