多奈哌齐联合奥氮平治疗伴精神行为症状血管性痴呆的远期疗效观察

摘要

目的：探讨不同剂量多奈哌齐与新型抗精神病药奥氮平联合使用治疗伴精神行为症状血管性痴呆（VaD）的远期疗效及安全性。方法选择2012年2月至2014年1月该院收治的80例伴精神行为症状VaD患者作为研究对象。依门诊号或住院号的末位数奇偶随机分组，奇数者为研究组，偶数者为对照组，每组各40例。研究组（大剂量组）服用多奈哌齐10 mg/d，奥氮平10 mg/d；对照组（小剂量组）服用多奈哌齐5 mg/d，奥氮平5 mg/d。治疗期间对两组患者进行不良反应量表（TESS）、简明精神病量表（BPRS）、Hachinski缺血指数记分表（HIS）、痴呆简易筛查量表（BSSD）、日常生活能力量表（ADL）评分比较。结果研究组治疗后3、6、9、12个月BPRS评分变化与对照组比较，差异有统计学意义（P＜0.05）；研究组治疗12个月后HIS、BSSD、ADL评分变化与对照组比较，差异均有统计学意义（P＜0.05）；两组患者治疗及随访期间无不良反应发生。结论多奈哌齐联合奥氮平治疗伴精神行为症状VaD远期疗效明显、不良反应小、安全可靠，值得在临床上推广应用。%Objective To explore the long-term results and security of different doses of donepezil combined with novel antipsychotic drugs-olanzapine in treating behavioral and psychological symptoms of vascular dementia (VaD). Methods This study selected 80 patients with behavioral and psychological symptoms of VaD as research objects,who were received in the hospital from February 2012 to January 2014. According to the last number of admission number (AD),all the patients were divided into research group(with odd number) and control group(with even number),40 cases in each group. The research group(high-dose group) was administered with 10 mg donepezil and 10 mg olanzapine daily;the control group(low-dose group) was taken 5 mg donepezil and 5 mg olanzapine daily. During treatment ,comparison between the two group was conducted on the Treatment Emer-gent Symptom Scale (TESS),Brief Psychiatric Rating Scale (BPRS),Hachinski Ischemic Score (HIS),Brief Screening Scale for Dementia(BSSD) and activity of daily living scale(ADL). Results The difference between the research group and control group on BRPS changes 3,6,9,12 months after treatment was statistically significant(P<0.05). 12 months after treatment,the changes of HIS,BSSD and ADL between the two groups had statistically significant difference (P<0.05). No adverse reactions occurred in patients of the two groups during the treatment and the follow-up. Conclusion Donepezil combined with olanzapine has obvious effect with less adverse reaction on behavior and physical symptoms of VaD ,it is worthy of clinical promotion due to safety and security.