CAJ | 학술논문

目的评价纳洛酮及纳洛酮联合氟哌啶醇治疗老年性谵妄的疗效及安全性,进一步探讨纳洛酮的治疗效果.方法采用前瞻性随机对照设计,分成3组:氟哌啶醇组、纳洛酮组以及两者联合组.分别在治疗前、治疗结束进行谵妄量表(DSS)测评.每天进行临床大体印象量表病情严重程度(CGI-SI)评分,评估起效时间及谵妄的改善情况.激越一镇静分级量表(ACES)在每次用药前后进行评分,评估对兴奋激越的效果.不良反应症状量表(TESS)测评药物毒副作用.结果氟哌啶醇组、纳洛酮组以及联合组用药时间[(4.0±2.9)d；(4.2±3.5)d；(3.2±3.2)d],3组多重比较差异无统计学意义(P＞ 0.05)；起效时间[(2.4±1.6)d；(2.4±1.4)d；(1.3±0.9)d],联合组快于其他两组(均P＜0.05).3组治疗结束DSS分别为[(18.8±11.5)分；(27.7±7.2)分；(29.5±5.6)分],纳洛酮组和联合组差异无统计学意义(P＞0.05),均较氟哌啶醇组恢复程度好(均P＜0.01)；CGI-SI分别为[(3.3±1.5)分；(2.5±1.5)分；(1.8±0.9)分],联合组效果好于氟哌啶醇组(P＜0.01),和纳洛酮组差异无统计学意义(P＞0.05).3组用药前ACES评分差异无统计学意义(P＞0.05),用药后分别为[(5.9±1.6)分；(6.2±1.8)分；(6.4±1.6)分],3组多重比较差异无统计学意义(P＞ 0.05)；TESS测评氟哌啶醇组有4例锥体外系症状,联合组有2例,x2检验差异无统计学意义(P＞0.05),纳洛酮组无副作用.结论在疗效方面,联合治疗及纳洛酮治疗均略优于氟哌啶醇治疗,联合治疗起效稍快于纳洛酮单独治疗；在副作用方面:氟哌啶醇治疗和联合治疗大体相当,纳洛酮无副作用.提示阿片系统也参与了谵妄的病理生理过程.
목적 평개납락동급납락동연합불고정순치료노년성섬망적료효급안전성,진일보탐토납락동적치료효과.방법 채용전첨성수궤대조설계,분성3조:불고정순조、납락동조이급량자연합조.분별재치료전、치료결속진행섬망량표(DSS)측평.매천진행림상대체인상량표병정엄중정도(CGI-SI)평분,평고기효시간급섬망적개선정황.격월일진정분급량표(ACES)재매차용약전후진행평분,평고대흥강격월적효과.불량반응증상량표(TESS)측평약물독부작용.결과 불고정순조、납락동조이급연합조용약시간[(4.0±2.9)d；(4.2±3.5)d；(3.2±3.2)d],3조다중비교차이무통계학의의(P＞ 0.05)；기효시간[(2.4±1.6)d；(2.4±1.4)d；(1.3±0.9)d],연합조쾌우기타량조(균P＜0.05).3조치료결속DSS분별위[(18.8±11.5)분；(27.7±7.2)분；(29.5±5.6)분],납락동조화연합조차이무통계학의의(P＞0.05),균교불고정순조회복정도호(균P＜0.01)；CGI-SI분별위[(3.3±1.5)분；(2.5±1.5)분；(1.8±0.9)분],연합조효과호우불고정순조(P＜0.01),화납락동조차이무통계학의의(P＞0.05).3조용약전ACES평분차이무통계학의의(P＞0.05),용약후분별위[(5.9±1.6)분；(6.2±1.8)분；(6.4±1.6)분],3조다중비교차이무통계학의의(P＞ 0.05)；TESS측평불고정순조유4례추체외계증상,연합조유2례,x2검험차이무통계학의의(P＞0.05),납락동조무부작용.결론 재료효방면,연합치료급납락동치료균략우우불고정순치료,연합치료기효초쾌우납락동단독치료；재부작용방면:불고정순치료화연합치료대체상당,납락동무부작용.제시아편계통야삼여료섬망적병리생리과정.
Objective Compared with haloperidol treatment,naloxone and naloxone combined haloperidol treatments were assessed in their efficacy and safety for excited type delirium in elderly.Methods The elderly patients with delirium were divided into haloperidol treatment (H),naloxone treatment (N) and combined treatment (C) in a prospective randomized controlled design.Delirium score scale (DSS) was used before and after treatments respectively.Clinical global impression scale-severity of illness (CGI-SI) score was evaluated daily to assess the onset time and improvement of delirium.Agitation-calmness evaluation scale (ACES) observed calmness effect in agitated patients before and after every medication intervention.Treatment emergent symptom scale (TESS) assessed side effects of all medications.Results The duration of three groups(H(4.0 ±2.9)d,N(4.2± 3.5) d,C (3.2 ± 3.2) d) had no significant difference (P ＞ 0.05) by multiple comparison.Compared the onset time of three groups (H (2.4 ± 1.6) d,N (2.4 ± 1.4) d,C (1.3 ± 0.9) d),the combined group was faster than the other two groups (all P ＜ 0.05),no significant difference between the two groups(P ＞ 0.05).DSS scores had no significant differences (P＞ 0.05) in three groups before treatment,so did CGI-SI scores.In the end,DSS scores were(H:18.8 ± 11.5,N:27.7 ± 7.2,C:29.5 ± 5.6) respectively.Statistically naloxone group and combined group with no significant difference (P ＞ 0.05),were better than the haloperidol group (all P ＜ 0.01) in recovery.At the same time CGI-SI scores were (H:3.3 ± 1.5,N:2.5 ± 1.5,C:1.8 ± 0.9) respectively.Statistically combined group was better than the haloperidol group (P ＜ 0.01),and no significant difference with naloxone group (P ＞ 0.05).Three groups had no significant difference in ACES scores (P ＞ 0.05) before and after medication interventions(H:5.9 ± 1.6,N:6.2 ± 1.8,C:6.4 ± 1.6) (P ＞ 0.05).Haloperidol group had 4 cases of extrapyramidal symptom evaluated by TESS and combined group had 2 cases.Two groups had no significant difference (Chisquare test P ＞ 0.05) in extrapyramidal symptom incidence.The naloxone group showed no side effects.Conclusion Naloxone combined haloperidol is slight better than naloxone,more than haloperidol in terms of efficacy.Haloperidol equally with combined medication showed more side effects than naloxone.