目的 研究喹硫平聯(lián)合曲唑酮治療重度抑郁癥的臨床效果。方法 收集2012年6月—2014年6月在北京市門頭溝龍泉醫(yī)院住院及門診重度抑郁癥患者104人,采用隨機(jī)數(shù)字法將患者隨機(jī)分為治療組和對(duì)照組,每組各52人。對(duì)照組口服鹽酸曲唑酮片,100 mg/d起始,2周內(nèi)加至充分治療劑量300～400 mg/d。治療組在對(duì)照組的基礎(chǔ)上同時(shí)口服富馬酸喹硫平片,從100 mg/d起,1周內(nèi)增加劑量至300 mg/d,并根據(jù)病情調(diào)整劑量,最高劑量400 mg/d。兩組患者療程均為8周。分別在患者入組時(shí)及治療4、8周末進(jìn)行漢密爾頓抑郁量表(HAMD)(24項(xiàng)版)、藥物副作用量表(TESS)評(píng)估。結(jié)果 對(duì)照組和治療組的總有效率分別為78.84%、90.38%,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P < 0.05)。與治療前比較,治療組4、8周末HAMD總分顯著降低(P < 0.01),對(duì)照組8周末HAMD總分明顯降低(P < 0.05)。與對(duì)照組治療后比較,治療組治療前及治療4周末HAMD總分無明顯變化,8周末HAMD總分顯著降低(P < 0.01)。與治療前比較,治療組4周末焦慮軀體化、睡眠障礙評(píng)分差異均有統(tǒng)計(jì)學(xué)意義(P < 0.05),治療8周末焦慮軀體化、認(rèn)識(shí)障礙、睡眠障礙、絕望感評(píng)分差異顯著(P < 0.01),而對(duì)照組只有焦慮軀體化評(píng)分在治療8周末的變化有統(tǒng)計(jì)學(xué)意義(P < 0.05)。與對(duì)照組比較,治療組治療8周末焦慮軀體化、認(rèn)識(shí)障礙、睡眠障礙、絕望感評(píng)分明顯降低,差異顯著(P < 0.01)。結(jié)論 富馬酸喹硫平片聯(lián)合鹽酸曲唑酮片是治療重度抑郁癥有效且相對(duì)較安全的方法,值得臨床推廣應(yīng)用。

Objective To explore the clinical efficacy of quetiapine combined with trazodone in treatment of severe depression. Methods The patients with severe depression (104 cases) from inpatients and outpatients of Beijing Mentougou District Longquan Hospital from June 2012 to June 2014 were randomly divided into control and treatment groups, and each group had 52 cases. The patients in the control group were po administered with Trazodone Hydrochloride Tablets, started from 100 mg/d to full amounts of treatment 300 — 400 mg/d during two weeks. The patients in the treatment group were po administered with Quetiapine Fumarate Tablets on the basis of the treatment in the control group, started from 100 mg/d to 300 mg/d during one week, and even the highest dose 400 mg/d was adopted according to the condition of the patient dose. Both groups were treated for 8 weeks. Hamilton Depression Scale (HAMD) (24 items) and Treatment Emergent Symptom Scale (TESS) of adverse reactions were evaluated before treatment and treated for 4 and 8 weeks. Results After treatment, the total effective rate of control and treatment groups were 78.84% and 90.38%, respectively, and there were differences between two groups (P < 0.05). Compared with those before treatment, HAMD scores in treatment group treated for 4 and 8 weeks were significantly reduced (P < 0.01), while control group treated for 8 weeks was significantly reduced (P < 0.05). Compared with control group after treatment, HAMD scores of treatment group before treatment and treated for 4 weeks had no significant difference, but those of treatment group treated for 8 weeks were significantly reduced (P < 0.05). Scores of somatization disorder and sleep disorders in treatment group treated for 4 weeks were improved significantly compared with those of before treatment, and the difference was significant (P < 0.05). And scores of somatization disorder, cognitive disorder, sleep disorders, and hopelessness in treatment group treated for 8 weeks were improved significantly (P < 0.01). There was significant difference for scores of somatization disorder in treatment group treated for 4 weeks (P < 0.05). Compared with control group after treatment, scores of somatization disorder, cognitive disorder, sleep disorders, and hopelessness of treatment group treated for 8 weeks were significantly reduced with significant difference (P < 0.01). Conclusion Quetiapine Fumarate Tablets combined with Trazodone Hydrochloride Tablets is effective and safe relatively in treatment of severe depression, which is worth clinical promotion.