目的 探討酒石酸唑吡坦片聯(lián)合鹽酸帕羅西汀片治療抑郁失眠的臨床療效和安全性。方法 選取2012年12月-2014年12月上海中醫(yī)藥大學附屬龍華醫(yī)院就診的抑郁癥患者86例，隨機分為對照組和治療組，每組各43例。對照組患者飯后口服鹽酸帕羅西汀片10 mg，1次/d。治療組在對照組治療的基礎(chǔ)上睡前服用酒石酸唑吡坦片10 mg，1次/d。兩組藥物初始劑量均為10 mg，治療1周后酌情增加至20 mg。兩組均連續(xù)治療4周。治療后，評價兩組的臨床療效，同時比較兩組治療前后PSQI、HAMD-17、HAMA評分，血生化指標水平以及不良反應(yīng)發(fā)生情況。結(jié)果 治療后，對照組、治療組的總有效率分別為76.74%、93.02%，兩組總有效率比較差異具有統(tǒng)計學意義（P<0.05）。治療1周后，兩組HAMA評分均顯著降低，同組治療前后差異有統(tǒng)計學意義（P<0.05）。治療2、4周后，兩組PSQI、HAMD-17、HAMA評分均顯著降低，同組治療前后差異有統(tǒng)計學意義（P<0.05）；且治療組這些觀察指標同期的降低程度明顯優(yōu)于對照組，兩組比較差異具有統(tǒng)計學意義（P<0.05）。治療后，兩組γ-氨基丁酸（GABA）、5-羥色胺（5-HT）水平均顯著升高，同組治療前后差異具有統(tǒng)計學意義（P<0.05）；且治療組這些觀察指標的升高程度明顯優(yōu)于對照組，兩組比較差異具有統(tǒng)計學意義（P<0.05）。出現(xiàn)的主要不良反應(yīng)有頭暈、惡心與食欲不振、口干、腹瀉，兩組不良反應(yīng)發(fā)生率比較無統(tǒng)計學意義。結(jié)論 酒石酸唑吡坦片聯(lián)合鹽酸帕羅西汀片治療抑郁失眠具有良好的療效，可以緩解失眠癥狀，增加GABA和5-HT水平，不增加不良反應(yīng)，具有一定的臨床推廣應(yīng)用價值。

Objective To explore the clinical efficacy and safety of Zolpidem Tartrate Tablets combined with Paroxetine Hydrochloride Tablets in treatment of depression and insomnia. Methods Patients (86 cases) with depression in Longhua Hospital Shanghai University of Traditional Chinese Medicine from December 2012 to December 2014 were randomly divided into control and treatment group, and each group had 43 cases. The patients in the control group were po administered with Paroxetine Hydrochloride Tablets 10 mg after dinner, once daily. The patients in the treatment group were po administered with Zolpidem Tartrate Tablets on the basis of the control group 10 mg before sleeping, once daily. The initial dose of patients in two groups was 10 mg, and was increased to 20 mg in 1 week after treatment. The patients in two groups were treated for 4 weeks. After treatment, the clinical efficacies were evaluated, and PSQI score, HAMD-17 score, HAMA score, the blood biochemical indexes, and adverse reactions in two groups were compared. Result After treatment, the clinical efficacies in the control and treatment groups were 76.74% and 93.02%, respectively, and there were differences between two groups (P<0.05). After treatment for one week, HAMA score of two groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). After treatment for 2 and 4 weeks, PSQI, HAMD-17, and HAMA scores of two groups were obviously decreased, and the difference was statistically significant in the same group (P<0.05). And the scores in the treatment group were significantly lower than those of the control group in the same period, with significant difference between two groups (P<0.05). After treatment, the levels of GABA and 5-HT were significantly increased, and the difference was statistically significant in the same group (P<0.05). And the observational indexes in the treatment group were significantly higher than those in the control group, with significant difference between two groups (P<0.05). Major adverse reactions in two groups were dizziness, nausea, loss of appetite, dry mouth, and diarrhea, and there was no significant difference between two groups. Conclusion Zolpidem Tartrate Tablets combined with Paroxetine Hydrochloride Tablets has good clinical effect in treatment of depression and insomnia, can alleviate insomnia symptoms, increase the levels of GABA and 5-HT, and don't increase the adverse reaction, which has a certain clinical application value.