鲁　娜山东省临沂市精神卫生中心，山东临沂　276005

无抽搐电休克治疗伴顽固性幻听难治性精神分裂症安全和有效性研究

鲁娜
山东省临沂市精神卫生中心，山东临沂276005

目的探讨无抽搐电休克（modified electroconvulsive therapy，MECT）对伴有顽固性幻听难治性精神分裂症的治疗效果和安全性。方法以2014年8月～2015年12月我院收治60例既往使用各种抗精神病药物治疗的伴有顽固性幻听难治性精神分裂症患者联合进行无抽搐电休克治疗，疗程8～12次。采用阳性和阴性症状量表（positive and negative symptom scles，PANSS）、幻听量表（auditory hallucination rating scale，AHRS）评定疗效，同时以副反应量表（treatmentemergent symptom scales，TESS）、韦氏记忆量表（wechslermemory scale，WMS）来评定患者的不良反应情况。结果临床联合无抽搐电休克治疗后，患者的PANSS量表评分明显下降，幻听明显减少或消失，而TESS评分无明显变化，另外WMS评分首次行无抽搐电休克治疗后显著下降，但治疗2周后差异无明显变化（P＞0.05），无抽搐电休克治疗伴有幻听的难治性精神分裂症显效率55.7%，总有效率90.4%，无效9.6%。主要不良反应为锥体外系反应9例，由药物所致，经对症处理后消失，其他不良反应相对少见共8例，包括恶心1例、便秘3例、头晕1例、口干2例、心动过速1例，不影响继续治疗。无抽搐电休克治疗不良反应主要为暂时性记忆减退。结论无抽搐电休克治疗伴有幻听的难治性精神分裂症有良好疗效，安全性高，患者对副作用耐受性良好，其对认知功能的影响是短期和可逆的。

无抽搐电休克；幻听；精神分裂症；认知功能

［Abstract］Objective To study the clinical efficacy and safety ofmodified electroconvulsive therapy in the treatment of patients with schizophrenia.M ethods A total of 60 patients with schizophrenia from August 2014 to December 2015 were treatmented modified electroconvulsive therapy for 8-12 times.The positive and negative symptoms scale（PANSS）and（auditory hallucination rating scale，AHRS）were used to evaluated the efficacy，the treatment emergent symptoms scale（TESS）and wechslermemory scale，WMSwere used to assess the side effects.Results Clinical combined with modified electroconvulsive therapy，the patients of PANSS scale score decreased significantly，auditory hallucinations were significantly decreased or disappeared，and Tess scores did not change significantly.In addition，WMS scores first modified electroconvulsive therapy（MECT）significantly decreased，but the treatment 2 weeks after differences had no significant change（P＞0.05），non convulsively electroconvulsive therapy in the treatment of patientswith auditory hallucination of refractory spirit schizophrenia significant efficiency was 55.7%，efficiency was 90.4%；invalid was 9.6%.Major adverse reaction of extrapyramidal system reaction in 9 cases，caused by the drug，after symptomatic treatment disappeared and other adverse reactionswere relatively rare in 8 cases，including 1 case of nausea，constipation in 3 cases，1 case of dizziness，drymouth in 2 cases，tachycardia tachycardia 1 case，which not affected the continued treatment. Themain adverse effects ofmodified electric shock therapy were temporarymemory loss.Conclusion Modified electroconvulsive therapy was effective and safe in the treatment of schizophrenia.Congnitive impairment induced by MECT is transient and reversible.

［key words］Modified electroconvulsive therapy；Hallucination；Schizophrenia；Cognitive function

研究表明，抗精神病治疗精神分裂症的有效率一般在50%～80%［1］，而传统抗精神病药物对约30%～40%的精神分裂症患者无效或者仅部分有效［2］，这类患者公认属于“难治性精神分裂症”范畴。……