中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2015年
10期
760-764
,共5页
张珅%丁昌红%吴沪生%方方%王晓慧%任晓暾
張珅%丁昌紅%吳滬生%方方%王曉慧%任曉暾
장신%정창홍%오호생%방방%왕효혜%임효돈
发作性睡病%儿童%盐酸托莫西汀
髮作性睡病%兒童%鹽痠託莫西汀
발작성수병%인동%염산탁막서정
Narcolepsy%Child%Atomoxetine hydrochloride
目的 探讨盐酸托莫西汀治疗儿童发作性睡病的临床疗效和安全性.方法 应用盐酸托莫西汀治疗2010年11月至2014年12月北京儿童医院确诊的符合睡眠障碍国际分类(ICSD-2)诊断标准的发作性睡病患儿66例(男42例、女24例),平均发病年龄7岁6个月(3岁9个月至13岁),平均病程1年9个月(3个月至5年),平均随访18个月(2~ 49个月),观察其临床疗效和不良反应.结果 66例发作性睡病患儿治疗后62例白天过度睡眠得到改善,其中完全控制11例(16.7%)、明显好转29例(43.9%)、好转22例(33.3%);54例患儿存在大笑后肢体无力猝倒,经治疗症状完全控制18例(33.3%)、明显好转19例(35.2%),好转10例(18.5%);55例有夜间睡眠障碍的患儿治疗后47例症状改善,完全好转14例(25.5%)、明显好转20例(36.4%)、好转13例(23.6%);13例患儿入睡或清醒过程中存在幻觉,仅4例治疗后症状完全缓解;4例患儿有睡眠瘫痪,仅1例治疗后症状完全缓解.经治疗18例患儿注意力集中时间延长,学习效率提高,成绩明显进步.不良反应:用药后出现食欲不振18例,情绪不稳定5例,抑郁2例,夜尿增多、肌肉震颤、伸舌各1例,心电图出现P-R间期延长、房性早搏1例.结论 盐酸托莫西汀对发作性睡病的白天过度睡眠、大笑后肢体无力以及夜间睡眠障碍均有良好的疗效,对睡眠幻觉及睡眠瘫痪部分患者有效.其不良反应程度轻微,以食欲不振、情绪不稳定多见.作为一种非中枢兴奋剂,治疗发作性睡病不受药物依赖性和处方限制,应用耐受性好,使用安全、有效,可作为治疗儿童发作性睡病的良好选择.
目的 探討鹽痠託莫西汀治療兒童髮作性睡病的臨床療效和安全性.方法 應用鹽痠託莫西汀治療2010年11月至2014年12月北京兒童醫院確診的符閤睡眠障礙國際分類(ICSD-2)診斷標準的髮作性睡病患兒66例(男42例、女24例),平均髮病年齡7歲6箇月(3歲9箇月至13歲),平均病程1年9箇月(3箇月至5年),平均隨訪18箇月(2~ 49箇月),觀察其臨床療效和不良反應.結果 66例髮作性睡病患兒治療後62例白天過度睡眠得到改善,其中完全控製11例(16.7%)、明顯好轉29例(43.9%)、好轉22例(33.3%);54例患兒存在大笑後肢體無力猝倒,經治療癥狀完全控製18例(33.3%)、明顯好轉19例(35.2%),好轉10例(18.5%);55例有夜間睡眠障礙的患兒治療後47例癥狀改善,完全好轉14例(25.5%)、明顯好轉20例(36.4%)、好轉13例(23.6%);13例患兒入睡或清醒過程中存在幻覺,僅4例治療後癥狀完全緩解;4例患兒有睡眠癱瘓,僅1例治療後癥狀完全緩解.經治療18例患兒註意力集中時間延長,學習效率提高,成績明顯進步.不良反應:用藥後齣現食欲不振18例,情緒不穩定5例,抑鬱2例,夜尿增多、肌肉震顫、伸舌各1例,心電圖齣現P-R間期延長、房性早搏1例.結論 鹽痠託莫西汀對髮作性睡病的白天過度睡眠、大笑後肢體無力以及夜間睡眠障礙均有良好的療效,對睡眠幻覺及睡眠癱瘓部分患者有效.其不良反應程度輕微,以食欲不振、情緒不穩定多見.作為一種非中樞興奮劑,治療髮作性睡病不受藥物依賴性和處方限製,應用耐受性好,使用安全、有效,可作為治療兒童髮作性睡病的良好選擇.
목적 탐토염산탁막서정치료인동발작성수병적림상료효화안전성.방법 응용염산탁막서정치료2010년11월지2014년12월북경인동의원학진적부합수면장애국제분류(ICSD-2)진단표준적발작성수병환인66례(남42례、녀24례),평균발병년령7세6개월(3세9개월지13세),평균병정1년9개월(3개월지5년),평균수방18개월(2~ 49개월),관찰기림상료효화불량반응.결과 66례발작성수병환인치료후62례백천과도수면득도개선,기중완전공제11례(16.7%)、명현호전29례(43.9%)、호전22례(33.3%);54례환인존재대소후지체무력졸도,경치료증상완전공제18례(33.3%)、명현호전19례(35.2%),호전10례(18.5%);55례유야간수면장애적환인치료후47례증상개선,완전호전14례(25.5%)、명현호전20례(36.4%)、호전13례(23.6%);13례환인입수혹청성과정중존재환각,부4례치료후증상완전완해;4례환인유수면탄탄,부1례치료후증상완전완해.경치료18례환인주의력집중시간연장,학습효솔제고,성적명현진보.불량반응:용약후출현식욕불진18례,정서불은정5례,억욱2례,야뇨증다、기육진전、신설각1례,심전도출현P-R간기연장、방성조박1례.결론 염산탁막서정대발작성수병적백천과도수면、대소후지체무력이급야간수면장애균유량호적료효,대수면환각급수면탄탄부분환자유효.기불량반응정도경미,이식욕불진、정서불은정다견.작위일충비중추흥강제,치료발작성수병불수약물의뢰성화처방한제,응용내수성호,사용안전、유효,가작위치료인동발작성수병적량호선택.
Objective To observe the efficacy and safety of atomoxetine hydrochloride in children with narcolepsy.Method Totally 66 patients with narcolepsy who were conformed international classification of sleep disturbances (ICSD-2) diagnostic criteria treated with atomoxetine hydrochloride seen from November 2010 to December 2014 were enrolled into this study,42 of them were male and 24 female,mean age of onset was 7.5 years (3.75-13.00 years),mean duration before diagnosis was 1.75 years (0.25-5.00 years).Complete blood count,liver and kidney function,multiple sleep latency test (MSLT),polysomnography(PGS),neuroimaging and electroencephalography (EEG) were performed for each patient.For some of the children HLA-DR2 gene and serum markers of infection were tested.The 66 cases were followed up from 2 to 49 months (average 18 months) to observe the clinical efficacy and adverse reactions.Results In 62 cases excessive daytime sleepiness was improved,in 11 cases (16.7%) it was controlled (16.7%),in 29 cases (43.9%)the treatment was obviously effective and in 22 (33.3 %) it was effective;cataplexy occurred in 54 cases,in 18 (33.3%) it was controlled,in 19 (35.2%) the treatment was obviously effective and in 10(18.5%) effective;night sleep disorders existed in 55 cases,in 47 cases it was improved,in 14(25.5%) it was controlled,in 20 (36.4%)the treatment was obviously effective and in 13 (23.6%)effective;hypnagogic or hypnopompic hallucination was present in 13 cases,in only 4 these symptoms were controlled.Sleep paralysis existed in 4 cases,it was controlled in only 1 case.In 18 cases attention and learning efficiency improved.Anorexia occurred in 18 cases,mood disorder in 5 cases,depression in 2 cases,nocturia,muscle tremors,involuntary tongue movement each occurred in 1 case.P-R interval prolongation and atrial premature contraction were found in 1 case.Conclusion Atomoxetine hydrochloride showed good effects in patients with narcolepsy on excessive daytime sleepiness,cataplexy and night sleep disorders,the effects on hallucinations and sleep paralysis were not significant.Adverse reactions were slight,anorexia and mood disorder were common.As a non-central nervous system stimulant,atomoxetine hydrochloride does not induce drug dependence and has no prescription limits;it has good tolerability,safety and effectiveness,it can be a good alternative in treatment of children with narcolepsy.