喹硫平对住院酒依赖患者稽延性戒断症状及脑电生理活动的影响

发布时间：2018-03-24 01:24

本文选题：喹硫平　切入点：酒依赖　出处：《新乡医学院》2013年硕士论文

【摘要】：背景长期大量饮酒可带来严重的躯体损害、精神神经损害和社会损害。精神神经损害包括酒依赖相关精神障碍和认知功能障碍。目前酒依赖已成为世界性公共卫生问题,严重影响着个体健康、家庭幸福和社会安定。酒依赖者戒酒后1年复饮率高达50%。复饮可能与焦虑、抑郁、失眠等“稽延性戒断症状”密切相关。美国FDA批准的三种用于治疗酒依赖及复发的药物,戒酒硫、纳曲酮和阿坎酸虽然都有一定疗效,但在临床总体评价中均有其弊端,所以寻找新的治疗药物有重要临床意义。鉴于国外动物实验显示喹硫平可有效减轻酒精戒断体征并具有神经保护作用,临床试验也显示喹硫平改善酒依赖患者睡眠障碍,增加保持戒酒天数和减少住院天数,减少酒精消耗量等。为此,本研究评估喹硫平对住院酒依赖患者稽延性戒断症状的治疗效果及其对脑电生理活动的影响。目的 1、评估喹硫平对住院酒依赖患者稽延性戒断症状的治疗效果。 2、探讨喹硫平对住院酒依赖患者急性戒断后睡眠质量和睡眠结构的影响。 3、探讨喹硫平对住院酒依赖患者急性戒断后事件相关电位和探究性眼动的影响。方法 l、按入组标准选取2012年4月至2013年2月在新乡医学院第二附属医院住院的酒依赖患者,随机分为喹硫平治疗组(喹硫平组)和维生素治疗组(对照组)。所有入组患者入院后予为期1周的急性期戒酒治疗,即常规予苯二氮卓类药物替代递减以及维生素对症治疗。设定1周末为研究基线期,自基线期开始,喹硫平组予可变剂量的富马酸喹硫平片(200-400mg/d)治疗。对照组继续予维生素治疗。治疗为期4周,若患者提前出院,则门诊复查。 2、喹硫平组和对照组分别于基线期和治疗4周末评定宾西法尼亚酒精渴求量表(PACS)、视觉模拟渴求量表(VAS)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、匹兹堡睡眠质量指数(PSQI)以评价喹硫平对稽延性戒断症状的治疗效果。 3、喹硫平组和对照组分别于基线期和喹硫平治疗4周末接受多导睡眠图(PSG)检测,以了解喹硫平对酒依赖患者戒断后睡眠结构和睡眠质量的影响。 4、喹硫平组和对照组分别于基线期和喹硫平治疗4周末接受ERP-P300和眼动分析(EEM)检测,以了解喹硫平对酒依赖患者戒断后对事件相关电位P300和探究性眼动的影响。 5、所有数据均采用SPSS16.0统计软件进行分析,计数资料采用χ2检验,计量资料用均数和标准差表示。治疗前后的组内两两比较采用配对t检验,组间两两比较采用独立样本t检验。以P0.05为有统计学意义。结果 1、临床疗效评定结果治疗前相比,两组PACS、VAS、HAMD、HAMA量表评分差异无统计学意义(P0.05)；治疗后组内相比,喹硫平组治疗后PACS、VAS、 HAMD、HAMD量表总分较治疗前均显著降低,差异有统计学意义(P0.05)：而对照组量表分值改变不明显,差异无统计学意义(P0.05)；治疗后组间相比,喹硫平组以上各量表得分较对照组均显著降低,差异具有统计学意义(P0.05)。 2、睡眠状况评定结果 PSQI治疗前相比,两组PSQI总分差异无统计学意义(P0.05)；治疗后组内相比,喹硫平组治疗后总分较治疗前显著降低,差异有统计学意义(P0.05)；治疗后组间相比,喹硫平组总分较对照组均显著降低,差异有统计学意义(P0.05)。 PSG治疗前相比,两组PSG各指标差异不显著(P0.05)；治疗后组内相比,喹硫平组SE较治疗前升高,差异有统计学意义(P0.05), TST较治疗前增加,差异有统计学意义(P0.05)；对照组治疗前后各指标变化不大,差异无统计学意义(P0.05)。治疗后组间相比,喹硫平组AN较对照组减少,差异有统计学意义(P0.05)；SE较对照组升高,差异有统计学差异(P0.05),TST较对照组增加,差异有统计学意义(P0.05)。 3、ERP结果治疗前相比,两组ERP测定中各指标差异无统计学意义(P0.05)；治疗后组内相比,喹硫平组治疗后N2及P3潜伏期较治疗前均显著缩短,P3波幅升高,差异有统计学意义(P0.05),而对照组改变不明显,差异无统计学意义(P0.05)；治疗后组间相比,喹硫平组N2及P3潜伏期较对照组均显著缩短,P3波幅升高,差异具有统计学意义(P0.05) 4、EEM结果治疗前相比,两组凝视点数(NEF)和反应性探索评分(RSS)差异无统计学意义(P0.05)；治疗后组内相比,喹硫平组治疗后NEF及RSS较治疗前均显著增加,差异有统计学意义(P0.05),而对照组改变不明显,差异无统计学意义(P0.05)；治疗后组间相比,喹硫平组NEF及RSS较对照组均显著增加,差异具有显著性意义(P0.05) 结论 1、喹硫平可改善酒依赖患者急性戒断后的心理渴求、焦虑、抑郁、失眠等稽延性戒断症状。 2、喹硫平可改善酒依赖患者急性戒断后睡眠质量,但短期内不能改善睡眠结构。 3、喹硫平可改善酒依赖患者急性戒断后脑电生理活动,可能有助于认知功能恢复。
[Abstract]:background
A large number of long-term drinking can lead to serious damage to the body, mental and social damage. Mental nerve damage nerve damage related mental disorders on cognitive dysfunction including wine and alcohol dependence. At present, the world has become a serious public health problem, affecting the individual health, family happiness and social stability. After 1 years of alcohol dependence on high relapse rate 50%. drink may be associated with anxiety, depression, insomnia and other "protracted withdrawal symptoms" are closely related. Three kinds of drugs for the treatment of alcohol dependence, and recurrence of FDA approved disulfiram, naltrexone and acamprosate have certain effect, but in the overall clinical evaluation has its own shortcomings, so finding has important clinical the significance of new therapeutic agents. In view of the foreign animal experiments show that quetiapine can effectively reduce alcohol withdrawal symptoms and has a neuroprotective effect, clinical trials also showed that quetiapine improved alcohol dependence patients Sleep disorder, increased to maintain abstinence duration and reduce hospitalization time, reduce alcohol consumption and so on. Therefore, the study on Evaluation of quetiapine in hospitalized patients with alcohol dependence of protracted withdrawal symptoms of the treatment effect and its influence on brain electrical physiological activities.
objective
1, the evaluation of quetiapine in hospitalized patients with alcohol dependence of protracted withdrawal symptoms of the treatment effect.
2, the effects of quetiapine on sleep quality and sleep structure after acute abstinence in hospitalized alcohol dependent patients were investigated.
3, the effects of quetiapine on event related potential and exploratory eye movement after acute abstinence in hospitalized alcohol dependent patients were investigated.
Method
L dependent patients according to the inclusion criteria from April 2012 to February 2013 in the Second Affiliated Hospital of Xinxiang Medical University Hospital of wine, were randomly divided into quetiapine group (quetiapine group) and vitamin treatment group (control group). All patients after admission to acute alcohol treatment for 1 weeks, which is received two benzodiazepines instead of decreasing and vitamin treatment. At the end of the 1 set of baseline, since the beginning of the baseline period, quetiapine group was treated with variable doses of Quetiapine Fumarate Tablets (200-400mg/d) treatment. The control group continued to vitamin therapy. Following 4 weeks of treatment, if the patient is discharged in advance, outpatient review.
2, quetiapine group and control group respectively at baseline and 4 weeks of treatment, evaluation of Pennsylvania alcohol craving scale (PACS), visual analogue scale (VAS), for the Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Pittsburgh sleep quality index (PSQI) to evaluate quetiapine the effect of doxepin in the treatment of protracted withdrawal symptoms.
3, quetiapine group and control group were tested with polysomnography (PSG) at baseline and quetiapine for 4 weeks to understand the effect of quetiapine on sleep structure and sleep quality after withdrawal.
4, quetiapine group and control group were examined by ERP-P300 and eye movement analysis (EEM) at baseline and quetiapine for 4 weeks respectively, so as to understand the effect of quetiapine on event-related potential P300 and exploratory eye movement after withdrawal.
5, all data were analyzed using statistical software SPSS16.0, count data using 2 test, said measurement data with mean and standard deviation. Before and after treatment in group 22 compared with paired t test, between the 22 groups was compared by independent sample t test. P0.05 had statistical significance.
Result
1, the clinical curative effect evaluation results compared to before treatment, two groups of PACS, VAS, HAMD, HAMA scale score difference was statistically significant (P0.05); compared to the treatment group, quetiapine group after treatment, PACS, VAS, HAMD, HAMD scores were significantly lower than before treatment, the difference was statistically significant (P0.05): control group scores did not change significantly, the difference was not statistically significant (P0.05); the treatment group compared with quetiapine group above the scores were significantly lower than the control group, the difference was statistically significant (P0.05).
2, the results of the sleep status assessment
Compared with PSQI before treatment, the two groups had no statistically significant difference between the total score of PSQI (P0.05); compared to the treatment group, quetiapine group after treatment were significantly lower than before treatment, the difference was statistically significant (P0.05); the treatment group compared with quetiapine group scores than the control group decreased significantly, there was statistical significant differences (P0.05).
Compared with PSG before treatment, the difference was not significant PSG index of the two groups (P0.05); compared with the treatment group, quetiapine group SE higher than that before treatment, the difference was statistically significant (P0.05), TST increased compared with that before the treatment, the difference was statistically significant (P0.05); the control group before and after treatment of each index did not change, the difference was not statistically significant (P0.05). After the treatment between the groups, quetiapine group AN decreased than the control group, the difference was statistically significant (P0.05); SE increased compared with the control group, there was significant difference (P0.05), TST increased compared to the control group, the difference was statistically significant (P0.05).
3, the ERP results compared to before treatment, two groups of ERP were no significant differences in each index (P0.05); compared to the treatment group, quetiapine group after the treatment of N2 and P3 latency were significantly shortened, the amplitude of P3 increased, the difference was statistically significant (P0.05), while no significant change in the control group, no statistically significant difference (P0.05); the treatment group compared with quetiapine group N2 and P3 latencies were significantly shorter than the control group, the amplitude of P3 increased, the difference was statistically significant (P0.05)
4, EEM results before the treatment, compared two groups of gaze points (NEF) and responsive search score (RSS) showed no significant difference (P0.05); compared to the treatment group, quetiapine group after the treatment of NEF and RSS were significantly increased, the difference was statistically significant (P0.05), and the control group the change is not obvious, the difference was not statistically significant (P0.05); the treatment group compared with quetiapine group NEF and RSS were significantly increased compared with the control group, the difference was significant (P0.05)
conclusion
1, quetiapine can improve patients with acute alcohol dependence after withdrawal of craving, anxiety, depression, insomnia and other protracted withdrawal symptoms.
2, quetiapine can improve the quality of sleep after acute abstinence in alcohol dependent patients, but it can not improve the sleep structure in the short term.
3, quetiapine can improve the electrophysiological activity of brain after acute abstinence in alcohol dependence, and may help to recover the cognitive function.

【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R749.62

【参考文献】