慕经纬

【摘要】 目的 对比探讨奥氮平、利培酮治疗老年痴呆精神行为症状的临床效果。方法 102例老年痴呆患者， 随机分为奥氮平组和利培酮组， 各51例。奥氮平组给予奥氮平片治疗， 利培酮组给予利培酮片治疗， 治疗2、4、8周后观察临床症状的改善情况， 并进行简明精神状态评分（MMSE）、痴呆病理行为评分（BE-HAVE）和阳性与阴性症状量表（PANSS）评分， 评定药物不良反应。结果 奥氮平组治疗总有效率为92.2%， 利培酮组治疗总有效率为90.2%， 两组比较差异无统计学意义（P>0.05）。两组治疗后2、4、8周敌对猜疑、思维障碍、行为紊乱、焦虑抑郁、偏执等评分比较差异均无统计学意义（P>0.05）。奥氮平组在治疗2、4周时PANSS评分低于利培酮组， 差异有统计学意义（P<0.05）。利培酮组发生锥体外系反应和恶心例数多于奥氮平组， 差异有统计学意义（P<0.05）。结论 奥氮平和利培酮治疗老年痴呆精神行为症状均有较好的疗效， 但奥氮平起效更快， 不良反应较少， 患者耐受性更好。

【关键词】 奥氮平；利培酮；老年痴呆；精神行为症状

DOI：10.14163/j.cnki.11-5547/r.2016.01.001

Clinical comparison and investigation of curative effects by olanzapine and risperidone in the treatment of behavioral and psychological symptoms of Alzheimers disease MU Jing-wei. First Department of Neurology， Liaoning Province Peoples Hospital， Shenyang 110016， China

【Abstract】 Objective To compare clinical effects by olanzapine and risperidone in the treatment of behavioral and psychological symptoms of Alzheimers disease. Methods A total of 102 patients with Alzheimers disease were randomly divided into olanzapine group and risperidone group， with 51 cases in each group. The olanzapine group received olanzapine tablets for treatment， and the risperidone group received risperidone tablets for treatment. Improvements of clinical symptoms were observed in 2， 4， and 8 weeks of treatment. Mini mental state examination （MMSE）， dementia pathological behavior score （BE-HAVE） and positive and negative syndrome scale （PANSS） were taken. Condition of adverse drug reactions was evaluated. Results The olanzapine group had total effective rate as 92.2%， and the risperidone group had that as 90.2%. Their difference had no statistical significance （P>0.05）. There was no statistically significant difference of scores in hostile suspicion， disturbance of thought， behavior disorders， anxiety-depression， and bigotry between the two groups after 2， 4 and 8 weeks of treatment （P>0.05）. The olanzapine group had lower PANSS score in 2 and 4 weeks of treatment than the risperidone group， and the difference had statistical significance （P<0.05）. The risperidone group had more cases with extrapyramidal side effects and nausea than the olanzapine group， and the difference had statistical significance （P<0.05）. Conclusion Both olanzapine and risperidone show good effect in treating behavioral and psychological symptoms of Alzheimers disease， while olanzapine provides quick onset， few adverse reactions， and good tolerance in patients.

【Key words】 Olanzapine； Risperidone； Alzheimers disease； Behavioral and psychological symptoms

老年痴呆是指60岁以上老年人出现持续性记忆障碍、思维障碍、失认、失语、视空间功能损害、执行能力障碍等症状的一种神经系统退行性疾病， 临床症状主要表现为日常生活能力下降、认知功能下降、行为障碍和精神症状， 根据认知能力和身体机能恶化程度分为轻度痴呆期、中度痴呆期和重度痴呆期[1]。随着人口老龄化及老年痴呆的患病率增加， 西方国家65岁人群患轻度痴呆者为10%左右， 中重度痴呆者为5%左右[2]。痴呆老年人的医疗和照顾给社会和家庭带来了很大负担， 是老年医学研究的重要课题。目前临床治疗老年痴呆主要以改善认知功能和控制伴发精神症状为主， 控制精神症状常用药物主要有抗焦虑药、抗抑郁药、抗精神病药、脑代谢赋活药物和作用于神经递质的药物。奥氮……