【摘要】 目的:观察具有较强催眠作用的抗抑郁药米氮平并合美沙酮对阿片类稽延性戒断症状患者焦虑情绪以及睡眠障碍的干预作用,并与单用美沙酮比较。方法:选择2005-01/03在佛山市顺德区伍仲佩纪念医院戒毒治疗中心接受脱毒治疗的120例患者为观察对象。随机分成治疗组和对照组,每组60例。对照组采用单一美沙酮治疗,40mg/L,静脉注射,1次/d。治疗组在美沙酮治疗同时并用米氮平进行干预,剂量为15mg,每晚睡前一次,口服。疗程2周。采用海洛因稽延性戒断症状评定量表评定患者戒断症状的改善情况。于治疗前,治疗后1,2周由同一位精神科医师进行评定。海洛因稽延性戒断症状评定量表包含焦虑情绪(烦躁、心慌)、躯体不适(全身乏力、全身难受、四肢不适、食欲差和肌肉关节疼痛)及睡眠障碍(易醒、早醒、入睡困难)3个主要症状的10个调查子项目,按症状项目的严重程度分为4级,各项得分相加为总分。评分标准:0无症状;1轻度,询问出;2中度,主诉症状,但能忍受;3重度,不能忍受。总分越高,稽延性戒断症状越严重。同时在治疗前及2周结束时对患者进行实验检查,分别测定肝功能,肾功能,电解质及脑电图。实验数据采用独立样本t检验,P<0.05为差异呈显著性。结果:120例均进入结果分析。①两组患者基线资料比较:治疗组与对照组患者在年龄,性别,婚姻,职业,教育程度及吸毒方式,吸毒剂量,吸毒时间等方面比较差异不显著(P>0.05)。②两组患者不同时间海洛因稽延性戒断症状评定量表总评分结果:治疗组和对照组治疗前无差异,治疗后1周,2周治疗组总评分显著低于对照组,差异显著犤(74.13±3.72),(84.65±3.90),t=15.13,P<0.01犦;犤(28.72±2.67),(51.28±3.02),t=43.37,P<0.01犦。③两组患者不同时间睡眠障碍评分结果:治疗组和对照组入睡困难在治疗后1周有差异(t=2.34,P<0.05),而早醒,易醒在治疗后1周两组无显著差异(t=-0.26,0.15,P>0.05)。治疗2周后治疗组睡眠障碍的入睡困难,早醒,易醒子项目的评分显著低于对照组(t=-5.11,-2.8,-3.38,P<0.01)。结论:合用米氮平组治疗第2周,即改善了患者的焦虑情绪和睡眠障碍,提高了治疗依从性,治疗效果优于单用美沙酮。更多还原

【Abstract】 AIM: To observe the interventional action of antidepressant remeron possessing powerful hypnosis action combined with methadone on anxious emotion and dyssomnia in patients with opium protracted abstinence symptom, in comparison with methadone only.METHODS: 120 heroin addict patients were selected from Detoxication Center of Wuzhongpei Memorial Hospital, Shunde District from January to March 2005, and were divided randomly therapy group and control group with 60 patients in each group. Only methadone was used in control group with 40 mg/L venous injection and once per day. Methadone combined with remeron (15 mg, oral taking before sleeping at night) was used for two weeks. Amelioration of abstinence symptom in patients was evaluated by heroin protracted abstinence symptom rating scale, which at first and second week pre- and post-treatment was evaluated by the same psychiatrist. The heroin protracted abstinence symptom rating scale included anxious emotion (agitated, flustered), body malaise (total body inertia, total body unbearable, limbs malaise, bad appetite, and muscle arthralgia) and dyssomnia (easy to wake up, early to wake up, difficult to sleep) three main symptom with ten investigative sub-item, which was divided into four grades according to severity level of symptom item. The scores of every item added to get general mark. Scoring standard: symptomless:0; mild: 1, demanded; moderate: 2, chief complaint, which can be suffered; severe: 3, which cannot be suffered. The higher the score was, the more severe the protracted abstinence symptom was. Meanwhile, at pre-treatment and the second week post-treatment, patients were examined experimentally, including liver function, renal function, electrolure and electroencephalogram. Independent exponent t test was conducted for experiment data and P < 0.05 was considered significant.RESULTS: Totally 120 patients were involved in the analysis of results. ① Comparison of base line data between the two groups: The differences were insignificant between treatment group and control group in the aspects of age, sex, marriage, occupation, education level, way of drug abuse, amount of drug abuse and time of drug abuse, etc. (P > 0.05). ② General comment of different time in patients in the two groups by heroin protracted abstinence symptom rating scale: There were no differences pre-treatment between treatment group and control group. The general scores of treatment group were significantly lower than that of control group one week and two weeks post-treatment (74.13±3.72),(84.65±3.90) points, (t=15.13, P < 0.01); (28.72±2.67), (51.28±3.02) points, (t=43.37, P < 0.01). ③ The scores of dyssomnia at different times in patients in the two groups: The patients who were hard to get to sleep in treatment group and control group had difference one week post-treatment (t=2.34, P < 0.05), while the patients who were get up early and easy to go to sleep had no significant difference one week post-treatment (t=-0.26, 0.15, P > 0.05). Two weeks post-treatment scores of patients in treatment group who were hard to go to sleep, get up early and easy to be wake up were significantly lower than that of control group (t=-5.11,-2.8,-3.38, P < 0.01=. CONCLUSION: At the second week anxious emotion and dyssomnia of patients who are treated by methadone combined with remeron have been ameliorated, and treatment compliance has been enhanced, and the therapeutic efficacy is better than single methadone.更多还原