纳洛酮联合奥氮平治疗老年谵妄的随机对照研究

发布时间：2018-02-11 08:26

  本文关键词： 谵妄 老年人 纳洛酮 奥氮平　出处：《中国全科医学》2015年17期 　论文类型：期刊论文

【摘要】：目的探讨纳洛酮联合奥氮平治疗老年谵妄的疗效、起效时间及安全性。方法选取2010年1月—2013年10月在浙江萧山医院住院期间发生老年谵妄的患者66例,采用随机数字表法将患者分为试验组和对照组,各33例。两组均根据谵妄病因给予针对性治疗,试验组在此基础上给予奥氮平治疗,起始剂量1.25~2.50 mg/d,之后剂量在1.25~10.00 mg/d调整,同时给予0.9%氯化钠溶液100 ml+纳洛酮0.8 mg,静脉滴注,1次/d。对照组给予奥氮平口服或舌下含服治疗,起始剂量1.25~2.50 mg/d,之后剂量在1.25~10.00 mg/d调整。分别在两组患者治疗前、治疗第1~7天,以临床总体印象量表(CGI-SI、CGI-GI)分别评价患者精神障碍严重程度及症状改善情况,并将观察期内CGI-SI基线分减少≥1分时用药剂量及时间分别作为起效剂量和起效时间。在观察期内由会诊医生评定患者谵妄分级量表-98修订版(DRS-R-98)评分。结果对照组因自动出院脱落3例,转ICU插管上呼吸机治疗脱落1例,共完成29例;试验组因自动出院脱落1例,共完成32例。两组治疗前CGI-SI评分比较,差异无统计学意义(P0.05);试验组治疗后CGI-SI评分低于对照组(P0.05);两组治疗后CGI-SI评分均较治疗前降低(P0.05)。治疗后,对照组显效率为69.0%(20/29),低于试验组的96.9%(31/32)(χ2=6.60,P0.05)。试验组起效剂量低于对照组,起效时间短于对照组(P0.05)。两组治疗前后DRS-R-98评分时间与组间存在交互作用(P0.05);组间比较:两组治疗第2~5天,试验组DRS-R-98评分均低于对照组(P0.05);不同时间点比较:对照组治疗第3~7天DRS-R-98评分均低于治疗前,试验组治疗第2~7天DRS-R-98评分均低于治疗前(P0.05)。两组在观察期内均无因严重的药物不良反应而中断治疗者。结论纳洛酮联合奥氮平治疗老年谵妄起效快、疗效好,奥氮平的起效剂量低,使用剂量小,安全性高。
[Abstract]:Objective to investigate the efficacy, onset time and safety of naloxone combined with olanzapine in the treatment of senile delirium. Methods 66 cases of senile delirium in Zhejiang Xiaoshan Hospital from January 2010 to October 2013 were selected. Patients were divided into trial group and control group with 33 cases each. The two groups were given targeted treatment according to the etiology of delirium. The experimental group was treated with olanzapine at the initial dose of 1.25 ~ 2.50 mg / d, then the dose was adjusted at 1.25 ~ 10.00 mg/d. The control group was given olanzapine oral or sublingual oral administration, the initial dose was 1.25 ~ 2.50 mg / d, and the later dose was adjusted at 1.25 ~ 10.00 mg/d. The severity of mental disorders and the improvement of symptoms were evaluated by CGI-SIN CGI-GI. The dosage and time of medication were taken as the effective dose and time when the baseline score of CGI-SI decreased 鈮，

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