陈文泽 陈雪芬 张君青 姜义彬

躯体化障碍者的治疗及其神经电生理指标的变化研究

陈文泽 陈雪芬 张君青 姜义彬

目的 探讨帕罗西汀治疗躯体化障碍患者的疗效及神经电生理指标的变化。方法 按序贯法对138例患者进行帕罗西汀20～50mg/d治疗8周，以90项症状清单（SCL-90）躯体化因子分、焦虑自评量表（SAS）和抑郁自评量表（SDS）作为心理学评估指标，以交感神经皮肤反应（SSR）中起始潜伏期和波幅作为神经电生理学指标来对照比较疗效及电生理学指标的变化。结果 研究组总有效率为84.80%，治疗8周末的SLC-90躯体化因子分、SAS和SDS评分较治疗前明显下降（P＜0.05或0.01）；与对照组比较，治疗前研究组起始潜伏期明显延长（P＜0.01），波幅明显降低（P＜0.05）；治疗后研究组起始潜伏期及波幅无统计学差异（P＞0.05）。结论 躯体化障碍存在神经电生理学指标的改变，帕罗西汀治疗能有效改善抑郁症状，恢复神经电生理学指标。

躯体化障碍 帕罗西汀 神经电生理

【 Abstract】 Objective To investigates the therapeutic efficacy of paroxitine for somatization disorder and corresponding changes on neuroelectrophysiology. Methods One hundred and thirty eight patients with somatization disorder were treated with paroxetine(mean dose 29.78±7.99mg/d)for 8 weeks using sequential approach.The Symptom Checklist 90(SGL-90), Self-Rating Depression Scale(SDS)and Self-Rating Anxiety Scale(SAS)were used to assay the therapeutic efficacy.The onset latency and amplitude of sympathetic skin reflex(SSR)was also measured before and after treatment. Results The efficacy rates of paroxetine on somatization disorder according to the somatic score of SCL-90 was 84.80%at wk 8.The somatic scores,SAS and SDS scores were all significantly decreased after 8-wk treatment(P＜0.05 or 0.01).The onset latency of the study group was significantly longer than that of group(P＜0.01),while the amplitude was significantly lower(P＞0.05)before treatment;while after treatment there was no significant difference between two groups(P＜0.05).Conclusion Paroxetine is effective for somatic disorder,leading to the improvement of symptoms and changes of neuro-electrophysiology of patients.

躯体化障碍以多种多样、反复出现、时常变化的躯体症状为主要特征，是精神科临床较常见的问题之一。躯体化障碍表现为多种躯体不适主诉而无相应的器质性病变，患者往往首诊于全科医院而延误了系统治疗。临床一般应用抗抑郁剂治疗躯体化障碍，随着新型抗抑郁剂的不断涌现，躯体化障碍的治疗前景有所拓宽。帕罗西汀是一种5-羟色胺再摄取抑制剂，通过选择性抑制5-羟色胺及去甲肾上腺素的再摄取，从而发挥抗抑郁作用。笔者采用帕罗西汀治疗和神经电生理指标的检测，观察临床疗效，为临床治疗提供参考依据。……