余鸽 徐方忠 汤路瀚 蔡晶晶

[摘要] 目的 觀察中西医结合个体化治疗儿童注意缺陷多动障碍（ADHD）的临床效果。 方法 选取2018年6月至2019年6月在杭州某大型中西医结合三甲医院诊断为ADHD的6～12岁患儿63例，分为治疗组33例（心脾两虚证15例，肝肾阴虚、肝阳上亢证18例）及对照组30例，进行病例对照研究。治疗组在西医诊断的基础上，根据中医四诊及自编中医评定表辨证后入组，进行中西医结合个体化治疗;对照组经西医诊断后，采用盐酸托莫西汀治疗及常规行为治疗。两组在治疗前及治疗16周后分别比较Conner多动指数、儿童多动症行为家长评定量表总分、Simon任务评价。 结果 治疗前两组患儿各项指标比较，差异无统计学意义（P>0.05）;治疗后治疗组Conner多动指数、儿童多动症行为家长评定量表总分、Simon任务错误个数均低于对照组，差异有统计学意义（P<0.05）。治疗组根据中医量表及中医四诊分为心脾两虚组和肝肾阴虚、肝阳上亢组，治疗后三组Conner多动指数、儿童多动症行为家长评定量表总分、Simon任务错误个数比较，差异有统计学意义（P<0.05）。 结论 中西医结合个体化治疗能更好地改善ADHD患儿的执行功能、注意缺陷和行为障碍。

[关键词] 穴位;个体化治疗;中西医结合;注意缺陷多动障碍

[中图分类号] R729          [文献标识码] A          [文章编号] 1673-9701（2021）07-0030-04

Clinical efficacy of integrated Chinese and western medicine individualized treatment of children with attention deficit hyperactivity disorder

YU Ge1   XU Fangzhong1   TANG Luhan1   CAI Jingjing2

1.Department of Clinical Psychology， Tongde Hospital of Zhejiang Province， Hangzhou   310012， China; 2.Department of Applied Psychology， Zhejiang Sci-tech University， Hangzhou   310018， China

[Abstract] Objective To observe the clinical efficacy of integrated Chinese and western medicine individualized treatment of children with attention deficit hyperactivity disorder（ADHD）. Methods Case-control studies were applied， and all the subjects were children aged 6 to 12 years who were diagnosed as ADHD in a large hospital of integrated Chinese and western medicine in Hangzhou from June 2018 to June 2019. A total of 63 cases were divided into the treatment group（n=15， with deficiency of both heart and spleen pattern; n=18， with liver and kidney yin deficiency and liver-yang hyperactivity pattern） and the control group（n=30）. The treatment group was divided into two groups according to the four diagnoses of TCM and self-made TCM evaluation form on the basis of western medicine diagnosis， and gave integrated Chinese and western medicine individualized treatment. The control group was treated with tamoxifen hydrochloride and conventional behavioral therapy after western medicine diagnosis. Conner hyperactivity index， total score of parents′ rating scale for children′s ADHD behavior and Simon task evaluation of the two groups were evaluated before treatment and 16 weeks after treatment. Results There were no significant differences between the two groups in each index before treatment（P>0.05）. After treatment， Conner hyperactivity index， total score of parents′ rating scale for children′s ADHD behavior and the number of mistake in Simon task were statistically significant lower in the treatment group than in the control group（P<0.05）. According to the four diagnoses of TCM and self-made TCM evaluation form， the treatment group was divided into deficiency of both heart and spleen group and liver and kidney yin deficiency and liver-yang hyperactivity group. After treatment， The differences were statistically significant in Conner hyperactivity index， total score of parents′ rating scale for children′s ADHD behavior and the number of mistake in Simon task of the three groups（P<0.05）. Conclusion Individualized treatment of integrated Chinese and western medicine can better improve the executive function， attention deficit and behavior disorder of children with ADHD.

[Key words] Acupoint; Individualized treatment; Integrated Chinese and western medicine; Attention deficit hyperactivity disorder

注意缺陷多动障碍（Attention defect hyperactivity disorder，ADHD）是一种儿童期常见的精神疾病。根据美国精神病协会制定的《精神障碍诊断和统计手册》第五版（DSM-V）标准，ADHD表现为持续的注意缺陷和（或）多动-冲动模式，干扰患儿的功能或发育，且有关症状在12岁前即出现，存在于2个或更多的场合之中。ADHD主要分为多动型、注意缺陷型和混合型三类。目前ADHD的发病率约为10%[1]，严重影响患儿儿童期的学习生活与社会功能。为更好地改善患儿的病情，尽早进行干预和治疗，本研究在西医常规药物治疗的基础上结合中医辨证分型，对ADHD患儿进行中西医结合个体化治疗，以探索更适合ADHD患儿的治疗方法，现报道如下。