王丽娜+潘飞+王东平+

[摘要] 目的 探讨文拉法辛联合氨磺必利治疗难治性抑郁症的临床效果及安全性。 方法 按照数字随机法将本院收治的59例难治性抑郁症患者分为对照组（29例）和观察组（30例）。对照组给予文拉法辛治疗，观察组给予文拉法辛+氨磺必利治疗。8周后，比较两组的临床疗效，观察治疗前后两组患者的汉密尔顿抑郁量表（HAMD-17）评分、汉密尔顿焦虑量表（HAMA）评分及副反应量表（TESS）评分情况。 结果 观察组总有效率为66.67%，高于对照组的44.83%，差异有统计学意义（P＜0.01）。治疗4周后观察组的HAMD焦虑躯体化因子分、认知障碍因子分、睡眠障碍因子分及总分均较对照组明显下降（P<0.05或P<0.01）。治疗2周后观察组的HAMA评分明显低于对照组（P<0.05或P<0.01）。两组患者的不良反应差异无统计学意义(P＞0.05)。 结论 文拉法辛联合氨磺必利治疗难治性抑郁症的临床效果显著，疗效优于单用文拉法辛，不良反应少，值得临床推广应用。

[关键词] 文拉法辛；氨磺必利；难治性抑郁症；精神病学

[中图分类号] R971+.43[文献标识码] A[文章编号] 1674-4721（2014）04（c）-0086-03

Clinical efficacy of venlafaxine combined with amisulpride in treatment of refractory depression

WANG Li-na PAN Fei WANG Dong-ping

The Second Department of Early Intervention,the Second Affiliated Hospital to Xinxiang Medical College in Henan Province,Xinxiang 453002,China

[Abstract] Objective To discuss the efficacy and safety of venlafaxine combined with amisulpride in the treatment of refractory depression.Methods 59 cases of patients with refractory depression were randomly divided into the observation group (30 cases) and control group (29 cases) by random number table.Amisulpride and venlafaxine were used to the observation group,while venlafaxine alone was used to the control group.After 8 weeks treatment,the clinical efficacy was compared between two groups.Hamilton depression scale (HAMD-17) score,Hamilton anxiety scale (HAMA) score and treatment emergent symptom scale (TESS) score were observed before and after treatment.Results The total effective rate of the observation group was 66.67%,higher than 44.83% of the control group,the difference was significant (P<0.01).After 4 weeks treatment,HAMD anxiety somatization score,cognitive impairment score,sleep disorders score and total score in the observation group decreased more than that in the control group respectively (P<0.05 or P<0.01).After 2 weeks treatment,HAMA score in the observation group was significantly lower than that in the control group (P<0.05 or P<0.01).The rate of adverse reactions in the two groups had no significant difference (P>0.05).Conclusion The combination of venlafaxine and amisulpride are more effective than venlafaxine alone in treating refractory depression,and their adverse reactions are mild,which are worthy of expansion in clinical practice.

[Key words] Venlafaxine;Amisulpride;Refractory depression;Psychiatry

难治性抑郁症指应用2种或2种以上不同类型的抗抑郁药足量、足疗程治疗后，仍不见效者[1]，占抑郁症患者的30%左右。文拉法辛是5-羟色胺（5-HT）和去甲肾上腺素（NE）再摄取抑制药，不良反应少，其缓释剂的临床疗效及抗焦虑作用已得到证实[2]，近年来文拉法辛及其联合方案治疗难治性抑郁症的疗效已被证实[3]。氨磺必利为非经典抗精神药物，具有独特的药理作用，作为治疗抑郁症的增效手段始见于20世纪80年代初[4]。本研究采用文拉法辛联合氨磺必利治疗难治性抑郁症，以探讨其可行性及安全性。

1 资料与方法

1.1 一般资料

选取2010年10月～2012年10月本院收治的59例难治性抑郁症患者为研究对象，纳入标准[5]：①中国精神疾病分类诊断标准第3版（CCMD-3）有关抑郁症诊断标准；……