盐酸丁咯地尔对不同亚型精神分裂症局部脑血流的影响
염산정각지이대불동아형정신분렬증국부뇌혈류적영향
Effect of buflomedil hydrochlorde on regional cerebral blood flow in different subtypes of schizophrenia
  • 万方数据
    中华神经医学杂志 중화신경의학잡지
    CHINESE JOURNAL OF NEUROMEDICINE
    2013年 8期 827-832 ,共6页

    钟智勇%黄泽萍%韩洪瀛%张晋碚

    종지용%황택평%한홍영%장진배

    精神分裂症%盐酸丁咯地尔%经颅多普勒%脑动脉血流 精神分裂癥%鹽痠丁咯地爾%經顱多普勒%腦動脈血流
    정신분렬증%염산정각지이%경로다보륵%뇌동맥혈류
    Schizophrenia%Buflomedil hydrochloride%Transcranial Doppler%Cerebral blood flow
    目的 探讨脑血管扩张药盐酸丁咯地尔对不同亚型精神分裂症局部脑血流的影响.方法 选择中山大学附属第三医院精神心理科自2007年2月至2009年2月收治的符合《中国精神障碍分类与诊断标准》第3版中精神分裂症诊断标准患者共286例,分型后分别在各型中按照随机数字表法分为治疗组(采用抗精神病药加盐酸丁咯地尔治疗)和安慰组(采用抗精神病药加安慰剂生理盐水),其中Ⅰ型86例(治疗组46例,安慰组40例)、Ⅱ型63例(治疗组34例,安慰组29例)、Ⅲ型137例(治疗组72例,安慰治疗组65例).在治疗第1天和治疗第4周末采用经颅多普勒(TCD)测量不同亚型中2组患者双侧大脑前动脉、大脑中动脉、大脑后动脉、椎动脉和基底动脉的血流量. 结果 (1)Ⅰ型精神分裂症:2组治疗前后及2组之间各项TCD检测结果比较差异均无统计学意义(P＞0.05).(2)Ⅱ型精神分裂症:在治疗第1天时,2组大脑各动脉血流量比较差异均无统计学意义(P＞0.05).在第4周末时,治疗组双侧大脑前动脉、大脑中动脉、大脑后动脉血流量明显高于安慰组,差异有统计学意义(P＜0.05)；同时治疗组双侧大脑前动脉、大脑中动脉、大脑后动脉血流量明显高于治疗第1天时,差异有统计学意义(P＜0.05),而安慰组大脑各动脉血流量与治疗第1天比较差异均无统计学意义(P＞0.05).(3)Ⅲ型精神分裂症:在治疗第1天时,2组大脑各动脉血流量比较差异均无统计学意义(P＞0.05).在第4周末时,治疗组左侧大脑前动脉、左侧大脑中动脉和右侧大脑中动脉脑血流量明显高于安慰治疗组,差异有统计学意义(P＜0.05)；同时治疗组双侧大脑前动脉、大脑中动脉血流量明显高于治疗第1天时,差异有统计学意义(P＜0.05),而安慰组大脑各动脉血流量与治疗第1天比较差异均无统计学意义(P＞0.05). 结论 (1)不同亚型精神分裂症的脑血流状况是不同的,Ⅱ型精神分裂症脑动脉血流量下降最明显,所涉及脑动脉最多,其次是Ⅲ型,而Ⅰ型则相对不明显.(2)精神分裂症脑动脉血流量的下降可能有一定的先后顺序,以左侧大脑中动脉最先开始.(3)Ⅱ型和Ⅲ型精神分裂症脑动脉血流量下降的情况是可以用药物进行干预的.
    목적 탐토뇌혈관확장약염산정각지이대불동아형정신분렬증국부뇌혈류적영향.방법 선택중산대학부속제삼의원정신심이과자2007년2월지2009년2월수치적부합《중국정신장애분류여진단표준》제3판중정신분렬증진단표준환자공286례,분형후분별재각형중안조수궤수자표법분위치료조(채용항정신병약가염산정각지이치료)화안위조(채용항정신병약가안위제생리염수),기중Ⅰ형86례(치료조46례,안위조40례)、Ⅱ형63례(치료조34례,안위조29례)、Ⅲ형137례(치료조72례,안위치료조65례).재치료제1천화치료제4주말채용경로다보륵(TCD)측량불동아형중2조환자쌍측대뇌전동맥、대뇌중동맥、대뇌후동맥、추동맥화기저동맥적혈류량. 결과 (1)Ⅰ형정신분렬증:2조치료전후급2조지간각항TCD검측결과비교차이균무통계학의의(P＞0.05).(2)Ⅱ형정신분렬증:재치료제1천시,2조대뇌각동맥혈류량비교차이균무통계학의의(P＞0.05).재제4주말시,치료조쌍측대뇌전동맥、대뇌중동맥、대뇌후동맥혈류량명현고우안위조,차이유통계학의의(P＜0.05)；동시치료조쌍측대뇌전동맥、대뇌중동맥、대뇌후동맥혈류량명현고우치료제1천시,차이유통계학의의(P＜0.05),이안위조대뇌각동맥혈류량여치료제1천비교차이균무통계학의의(P＞0.05).(3)Ⅲ형정신분렬증:재치료제1천시,2조대뇌각동맥혈류량비교차이균무통계학의의(P＞0.05).재제4주말시,치료조좌측대뇌전동맥、좌측대뇌중동맥화우측대뇌중동맥뇌혈류량명현고우안위치료조,차이유통계학의의(P＜0.05)；동시치료조쌍측대뇌전동맥、대뇌중동맥혈류량명현고우치료제1천시,차이유통계학의의(P＜0.05),이안위조대뇌각동맥혈류량여치료제1천비교차이균무통계학의의(P＞0.05). 결론 (1)불동아형정신분렬증적뇌혈류상황시불동적,Ⅱ형정신분렬증뇌동맥혈류량하강최명현,소섭급뇌동맥최다,기차시Ⅲ형,이Ⅰ형칙상대불명현.(2)정신분렬증뇌동맥혈류량적하강가능유일정적선후순서,이좌측대뇌중동맥최선개시.(3)Ⅱ형화Ⅲ형정신분렬증뇌동맥혈류량하강적정황시가이용약물진행간예적.
    Objective To investigate the effect ofbuflomedil hydrochlorde on regional cerebral blood flow in different subtypes of schizophrenia.Methods Two hundred and eighty-six patient met the diagnostic criteria of CCMD-3 for schizophrenia,admitted to our hospital from February 2007 to February 2009,were chosen in our study; patients of type Ⅰ (n=86),type Ⅱ (n=63) and type Ⅲ (n=137)were randomly divided into treatment group of type Ⅰ (n=46),placebo treatment group of type Ⅰ (n=40),treatment group of type Ⅱ (n=34),placebo treatment group of type Ⅱ (n=29),treatment group of type Ⅲ(n=72) and placebo treatment group of type Ⅲ (n=65).Patients from the treatment groups were treated with antipsychotics with buflomedil hydrochloride and those from placebo treatment groups were given antipsychotics with saline for 4 weeks.On the 1st day and at the end of the 4th week of treatment,cerebral blood flows of bilateral anterior cerebral artery,middle cerebral artery,posterior cerebral artery,vertebral artery and basilar arterywere were measured by transcranial Doppler (TCD).Results No statistically significant difference of cerebral blood flow was noted between the two groups of type Ⅰ before/after treatment,neither between before and after treatment in one of the groups (P＞0.05).For type Ⅱ schizophrenia,no statistically significant difference of cerebral blood flow was noted between the two groups on the 1st day of treatment (P＞0.05); however,at the end of 4th week of treatment,cerebral blood flow in the bilateral anterior cerebral artery,middle cerebral artery,posterior cerebral artery blood of the treatment group were significant greater than that in the placebo treatment group (P＜0.05); the cerebral blood flow in the bilateral anterior cerebral artery,middle cerebral artery,posterior cerebral artery blood of the treatment group at the end of 4th week of treatment was significantly higher than that on the 1 st day of treatment (P＜0.05),while no significant difference was noted in the placebo treatment group (P＞0.05).For type Ⅲ schizophrenia,at the end of 4th week of treatment,the cerebral blood flow in the treatment group in the left anterior cerebral artery,the left middle cerebral artery and right middle cerebral artery were significant greater than that in the placebo treatment group (P＜0.05); and that of the bilateral anterior cerebral artery and middle cerebral artery in the treatment group at the end of 4th week of treatment was significantly greater than that on the 1st day of treatment (P＜0.05).Conclusions Different subtypes of schizophrenia enjoys different cerebral blood flows:most significant decline in cerebral blood flow and largest number of cerebral arteries of type Ⅱ schizophrenia are noted,followed by type Ⅲ schizophrenia;cerebral blood flow of schizophrenia maybe have an order to decline and the left middle cerebral artery maybe the first; the changes of cerebral blood flow between before and after treatment show that the decline of cerebral blood flow can be inverted with drugs.
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