本文選題：喹硫平　切入點：酒依賴　出處：《新鄉(xiāng)醫(yī)學(xué)院》2013年碩士論文

【摘要】：背景 長期大量飲酒可帶來嚴(yán)重的軀體損害、精神神經(jīng)損害和社會損害。精神神經(jīng)損害包括酒依賴相關(guān)精神障礙和認(rèn)知功能障礙。目前酒依賴已成為世界性公共衛(wèi)生問題,嚴(yán)重影響著個體健康、家庭幸福和社會安定。酒依賴者戒酒后1年復(fù)飲率高達50%。復(fù)飲可能與焦慮、抑郁、失眠等“稽延性戒斷癥狀”密切相關(guān)。美國FDA批準(zhǔn)的三種用于治療酒依賴及復(fù)發(fā)的藥物,戒酒硫、納曲酮和阿坎酸雖然都有一定療效,但在臨床總體評價中均有其弊端,所以尋找新的治療藥物有重要臨床意義。鑒于國外動物實驗顯示喹硫平可有效減輕酒精戒斷體征并具有神經(jīng)保護作用,臨床試驗也顯示喹硫平改善酒依賴患者睡眠障礙,增加保持戒酒天數(shù)和減少住院天數(shù),減少酒精消耗量等。為此,本研究評估喹硫平對住院酒依賴患者稽延性戒斷癥狀的治療效果及其對腦電生理活動的影響。 目的 1、評估喹硫平對住院酒依賴患者稽延性戒斷癥狀的治療效果。 2、探討喹硫平對住院酒依賴患者急性戒斷后睡眠質(zhì)量和睡眠結(jié)構(gòu)的影響。 3、探討喹硫平對住院酒依賴患者急性戒斷后事件相關(guān)電位和探究性眼動的影響。 方法 l、按入組標(biāo)準(zhǔn)選取2012年4月至2013年2月在新鄉(xiāng)醫(yī)學(xué)院第二附屬醫(yī)院住院的酒依賴患者,隨機分為喹硫平治療組(喹硫平組)和維生素治療組(對照組)。所有入組患者入院后予為期1周的急性期戒酒治療,即常規(guī)予苯二氮卓類藥物替代遞減以及維生素對癥治療。設(shè)定1周末為研究基線期,自基線期開始,喹硫平組予可變劑量的富馬酸喹硫平片(200-400mg/d)治療。對照組繼續(xù)予維生素治療。治療為期4周,若患者提前出院,則門診復(fù)查。 2、喹硫平組和對照組分別于基線期和治療4周末評定賓西法尼亞酒精渴求量表(PACS)、視覺模擬渴求量表(VAS)、漢密爾頓抑郁量表(HAMD)、漢密爾頓焦慮量表(HAMA)、匹茲堡睡眠質(zhì)量指數(shù)(PSQI)以評價喹硫平對稽延性戒斷癥狀的治療效果。 3、喹硫平組和對照組分別于基線期和喹硫平治療4周末接受多導(dǎo)睡眠圖(PSG)檢測,以了解喹硫平對酒依賴患者戒斷后睡眠結(jié)構(gòu)和睡眠質(zhì)量的影響。 4、喹硫平組和對照組分別于基線期和喹硫平治療4周末接受ERP-P300和眼動分析(EEM)檢測,以了解喹硫平對酒依賴患者戒斷后對事件相關(guān)電位P300和探究性眼動的影響。 5、所有數(shù)據(jù)均采用SPSS16.0統(tǒng)計軟件進行分析,計數(shù)資料采用χ2檢驗,計量資料用均數(shù)和標(biāo)準(zhǔn)差表示。治療前后的組內(nèi)兩兩比較采用配對t檢驗,組間兩兩比較采用獨立樣本t檢驗。以P0.05為有統(tǒng)計學(xué)意義。 結(jié)果 1、臨床療效評定結(jié)果治療前相比,兩組PACS、VAS、HAMD、HAMA量表評分差異無統(tǒng)計學(xué)意義(P0.05)；治療后組內(nèi)相比,喹硫平組治療后PACS、VAS、 HAMD、HAMD量表總分較治療前均顯著降低,差異有統(tǒng)計學(xué)意義(P0.05)：而對照組量表分值改變不明顯,差異無統(tǒng)計學(xué)意義(P0.05)；治療后組間相比,喹硫平組以上各量表得分較對照組均顯著降低,差異具有統(tǒng)計學(xué)意義(P0.05)。 2、睡眠狀況評定結(jié)果 PSQI治療前相比,兩組PSQI總分差異無統(tǒng)計學(xué)意義(P0.05)；治療后組內(nèi)相比,喹硫平組治療后總分較治療前顯著降低,差異有統(tǒng)計學(xué)意義(P0.05)；治療后組間相比,喹硫平組總分較對照組均顯著降低,差異有統(tǒng)計學(xué)意義(P0.05)。 PSG治療前相比,兩組PSG各指標(biāo)差異不顯著(P0.05)；治療后組內(nèi)相比,喹硫平組SE較治療前升高,差異有統(tǒng)計學(xué)意義(P0.05), TST較治療前增加,差異有統(tǒng)計學(xué)意義(P0.05)；對照組治療前后各指標(biāo)變化不大,差異無統(tǒng)計學(xué)意義(P0.05)。治療后組間相比,喹硫平組AN較對照組減少,差異有統(tǒng)計學(xué)意義(P0.05)；SE較對照組升高,差異有統(tǒng)計學(xué)差異(P0.05),TST較對照組增加,差異有統(tǒng)計學(xué)意義(P0.05)。 3、ERP結(jié)果治療前相比,兩組ERP測定中各指標(biāo)差異無統(tǒng)計學(xué)意義(P0.05)；治療后組內(nèi)相比,喹硫平組治療后N2及P3潛伏期較治療前均顯著縮短,P3波幅升高,差異有統(tǒng)計學(xué)意義(P0.05),而對照組改變不明顯,差異無統(tǒng)計學(xué)意義(P0.05)；治療后組間相比,喹硫平組N2及P3潛伏期較對照組均顯著縮短,P3波幅升高,差異具有統(tǒng)計學(xué)意義(P0.05) 4、EEM結(jié)果治療前相比,兩組凝視點數(shù)(NEF)和反應(yīng)性探索評分(RSS)差異無統(tǒng)計學(xué)意義(P0.05)；治療后組內(nèi)相比,喹硫平組治療后NEF及RSS較治療前均顯著增加,差異有統(tǒng)計學(xué)意義(P0.05),而對照組改變不明顯,差異無統(tǒng)計學(xué)意義(P0.05)；治療后組間相比,喹硫平組NEF及RSS較對照組均顯著增加,差異具有顯著性意義(P0.05) 結(jié)論 1、喹硫平可改善酒依賴患者急性戒斷后的心理渴求、焦慮、抑郁、失眠等稽延性戒斷癥狀。 2、喹硫平可改善酒依賴患者急性戒斷后睡眠質(zhì)量,但短期內(nèi)不能改善睡眠結(jié)構(gòu)。 3、喹硫平可改善酒依賴患者急性戒斷后腦電生理活動,可能有助于認(rèn)知功能恢復(fù)。
[Abstract]:background
A large number of long-term drinking can lead to serious damage to the body, mental and social damage. Mental nerve damage nerve damage related mental disorders on cognitive dysfunction including wine and alcohol dependence. At present, the world has become a serious public health problem, affecting the individual health, family happiness and social stability. After 1 years of alcohol dependence on high relapse rate 50%. drink may be associated with anxiety, depression, insomnia and other "protracted withdrawal symptoms" are closely related. Three kinds of drugs for the treatment of alcohol dependence, and recurrence of FDA approved disulfiram, naltrexone and acamprosate have certain effect, but in the overall clinical evaluation has its own shortcomings, so finding has important clinical the significance of new therapeutic agents. In view of the foreign animal experiments show that quetiapine can effectively reduce alcohol withdrawal symptoms and has a neuroprotective effect, clinical trials also showed that quetiapine improved alcohol dependence patients Sleep disorder, increased to maintain abstinence duration and reduce hospitalization time, reduce alcohol consumption and so on. Therefore, the study on Evaluation of quetiapine in hospitalized patients with alcohol dependence of protracted withdrawal symptoms of the treatment effect and its influence on brain electrical physiological activities.
objective
1, the evaluation of quetiapine in hospitalized patients with alcohol dependence of protracted withdrawal symptoms of the treatment effect.
2, the effects of quetiapine on sleep quality and sleep structure after acute abstinence in hospitalized alcohol dependent patients were investigated.
3, the effects of quetiapine on event related potential and exploratory eye movement after acute abstinence in hospitalized alcohol dependent patients were investigated.
Method
L dependent patients according to the inclusion criteria from April 2012 to February 2013 in the Second Affiliated Hospital of Xinxiang Medical University Hospital of wine, were randomly divided into quetiapine group (quetiapine group) and vitamin treatment group (control group). All patients after admission to acute alcohol treatment for 1 weeks, which is received two benzodiazepines instead of decreasing and vitamin treatment. At the end of the 1 set of baseline, since the beginning of the baseline period, quetiapine group was treated with variable doses of Quetiapine Fumarate Tablets (200-400mg/d) treatment. The control group continued to vitamin therapy. Following 4 weeks of treatment, if the patient is discharged in advance, outpatient review.
2, quetiapine group and control group respectively at baseline and 4 weeks of treatment, evaluation of Pennsylvania alcohol craving scale (PACS), visual analogue scale (VAS), for the Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Pittsburgh sleep quality index (PSQI) to evaluate quetiapine the effect of doxepin in the treatment of protracted withdrawal symptoms.
3, quetiapine group and control group were tested with polysomnography (PSG) at baseline and quetiapine for 4 weeks to understand the effect of quetiapine on sleep structure and sleep quality after withdrawal.
4, quetiapine group and control group were examined by ERP-P300 and eye movement analysis (EEM) at baseline and quetiapine for 4 weeks respectively, so as to understand the effect of quetiapine on event-related potential P300 and exploratory eye movement after withdrawal.
5, all data were analyzed using statistical software SPSS16.0, count data using 2 test, said measurement data with mean and standard deviation. Before and after treatment in group 22 compared with paired t test, between the 22 groups was compared by independent sample t test. P0.05 had statistical significance.
Result
1, the clinical curative effect evaluation results compared to before treatment, two groups of PACS, VAS, HAMD, HAMA scale score difference was statistically significant (P0.05); compared to the treatment group, quetiapine group after treatment, PACS, VAS, HAMD, HAMD scores were significantly lower than before treatment, the difference was statistically significant (P0.05): control group scores did not change significantly, the difference was not statistically significant (P0.05); the treatment group compared with quetiapine group above the scores were significantly lower than the control group, the difference was statistically significant (P0.05).
2, the results of the sleep status assessment
Compared with PSQI before treatment, the two groups had no statistically significant difference between the total score of PSQI (P0.05); compared to the treatment group, quetiapine group after treatment were significantly lower than before treatment, the difference was statistically significant (P0.05); the treatment group compared with quetiapine group scores than the control group decreased significantly, there was statistical significant differences (P0.05).
Compared with PSG before treatment, the difference was not significant PSG index of the two groups (P0.05); compared with the treatment group, quetiapine group SE higher than that before treatment, the difference was statistically significant (P0.05), TST increased compared with that before the treatment, the difference was statistically significant (P0.05); the control group before and after treatment of each index did not change, the difference was not statistically significant (P0.05). After the treatment between the groups, quetiapine group AN decreased than the control group, the difference was statistically significant (P0.05); SE increased compared with the control group, there was significant difference (P0.05), TST increased compared to the control group, the difference was statistically significant (P0.05).
3, the ERP results compared to before treatment, two groups of ERP were no significant differences in each index (P0.05); compared to the treatment group, quetiapine group after the treatment of N2 and P3 latency were significantly shortened, the amplitude of P3 increased, the difference was statistically significant (P0.05), while no significant change in the control group, no statistically significant difference (P0.05); the treatment group compared with quetiapine group N2 and P3 latencies were significantly shorter than the control group, the amplitude of P3 increased, the difference was statistically significant (P0.05)
4, EEM results before the treatment, compared two groups of gaze points (NEF) and responsive search score (RSS) showed no significant difference (P0.05); compared to the treatment group, quetiapine group after the treatment of NEF and RSS were significantly increased, the difference was statistically significant (P0.05), and the control group the change is not obvious, the difference was not statistically significant (P0.05); the treatment group compared with quetiapine group NEF and RSS were significantly increased compared with the control group, the difference was significant (P0.05)
conclusion
1, quetiapine can improve patients with acute alcohol dependence after withdrawal of craving, anxiety, depression, insomnia and other protracted withdrawal symptoms.
2, quetiapine can improve the quality of sleep after acute abstinence in alcohol dependent patients, but it can not improve the sleep structure in the short term.
3, quetiapine can improve the electrophysiological activity of brain after acute abstinence in alcohol dependence, and may help to recover the cognitive function.

【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R749.62

【參考文獻】

相關(guān)期刊論文 前10條

1 張書芹,劉正學(xué);酒精所致精神障礙10年臨床分析[J];神經(jīng)疾病與精神衛(wèi)生;2004年03期

2 徐鶴定,陳俊,聞暉,胡鶯燕,倪曉東,鞏繼平,方貽儒,陳興時,王祖承;酒依賴的事件相關(guān)電位P300實驗研究[J];上海精神醫(yī)學(xué);2003年03期

3 項志清,陳月敏,顏文偉;探索性眼球活動試驗在精神分裂癥診斷中的價值[J];上海精神醫(yī)學(xué);2004年05期

4 穆俊林;呂路線;李恒芬;陳佐明;杜云紅;張疆莉;李玉鳳;;抑郁癥患者的探究性眼動與聽覺事件相關(guān)電位研究[J];臨床神經(jīng)電生理學(xué)雜志;2006年05期

5 趙玲;劉玉玲;周福華;;酒依賴患者探究性眼球軌跡運動分析[J];精神醫(yī)學(xué)雜志;2009年06期

6 潘超,韓永華,朱日升;首發(fā)精神分裂癥患者探究性眼球軌跡運動研究[J];中國臨床康復(fù);2005年32期

7 郭崧,杜萬君,王援朝,姜佐寧;酒依賴者認(rèn)知功能障礙的事件相關(guān)電位研究[J];中國藥物依賴性雜志;2001年04期

8 陳鋒;Andrew J Lawrence;梁建輝;;酒精濫用與成癮中樞神經(jīng)遞質(zhì)的研究進展[J];中國藥物依賴性雜志;2007年01期

9 李艷祥;王學(xué)義;;酒依賴對認(rèn)知功能的影響[J];中國藥物依賴性雜志;2009年05期

10 郭美萍;楊鵬;楊彩容;凌y，

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