小剂量奥氮平治疗老年COPD稳定期伴焦虑抑郁患者的随机对照研究

摘要

目的:探讨小剂量奥氮平治疗老年慢性阻塞性肺疾病(COPD)稳定期伴焦虑抑郁患者的效果.方法:采用前瞻性、随机对照组方法进行研究,将汉密尔顿焦虑量表(HAMA)>10分且汉密尔顿抑郁量表(HAMD)(17项)>12分的老年COPD患者74例为对照组和观察组,各37例,对照组给予艾斯西酞普兰治疗,观察组在对照组基础上给予小剂量奥氮平治疗,均以4周为1个疗程,共治疗2个疗程.比较治疗有效率、不良用药反应、6个月COPD急性加重再入院率;发放汉密尔顿焦虑量表(HAMA)评估焦虑程度,汉密尔顿抑郁量表(HAMD)(17项)评估抑郁程度,呼吸困难量表(mMRC)问卷评估呼吸困难程度,圣乔治呼吸问卷(SGRQ)评估生活质量,测定第一秒用力呼吸容积(FEV1)占预计值百分比(FEV1%)、FEV1/用力肺活量(FVC)、6min步行距离(6MWD).结果:观察组治疗有效率为91.89%明显高于对照组的72.97%,6个月COPD急性加重再入院率为10.81%明显低于对照组的29.73%;观察组治疗后HAMA评分、HAMD评分、mMRC评分、SGRQ评分明显低于对照组,6MWD明显高于对照组;观察组治疗后FEV1%、FEV1/FVC明显高于对照组;两组不良反应无差异.结论:小剂量奥氮平治疗老年COPD稳定期伴焦虑抑郁效果确切,能改善肺功能,提高生活质量.%Objective To study the effects of low-dose olanzapine in the treatment of elderly patients with chronic obstruc-tive pulmonary disease(COPD)in stable phase complicated with anxiety and depression. Methods The prospective, randomized control method was used for study.74 elderly patients with COPD whose Hamilton Anxiety Scale(HAMA)score> 10 points and Hamilton Depression Scale(HAMD)(17 items)score>12 points were divided into the observation group and the control group, 37 cases in each. The control group was treated with Athy citalopram. On the basis, the observation group was treated with low-dose olanzapine. Both of the two groups took 4 weeks as a course of treatment and were treated for 2 courses. The response rate, adverse drug reactions and rate of 6-month COPD acute exacerbation caused readmission were compared; The Hamilton Anxiety Scale(HAMA)was issued to evaluate the degree of anxiety, and Hamilton Depression Scale(HAMD)(17 items)was used to evaluate the degree of depression. The dyspnea scale(mMRC)questionnaires were used to evaluate the degree of difficulty in breathing, and the St. George's Respiratory Questionnaire(SGRQ)was used to evaluate the quality of life. The percentage of forced expiratory volume in 1 second(FEV1)in predicted value(FEV1%), FEV1 / forced vital capacity(FVC)and 6 min walking distance(6MWD)were determined. Results The response rate in the observation group(91.89%)was significantly higher than that in the control group(72.97%), while the rate of 6-month COPD acute exacerbation caused readmission(10.81%)was significantly lower than that in the control group(29.73%); After treatment, HAMA score, HAMD score, mMRC score and SGRQ score of the observation group were significantly lower than those of the control group, and 6MWD was significantly longer than that of the control group; After treatment, FEV1% and FEV1/FVC of observation group were significantly higher than those of the control group; There was no significant difference in adverse reactions between the two groups. Conclusion The effect of low-dose olanzapine in treatment of elderly patients with COPD complicated with anxiety and depression is exact. It can improve lung function and quality of life.