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背景:注意缺陷或多动障碍通常采用精神兴奋类药物治疗,此类药物已经显示对大多数儿童的认知和行为障碍起改善作用。目的:比较奥氮平与哌醋甲酯治疗儿童多动症的临床疗效及不良反应。设计:病例对比观察。单位:北京回龙观医院精神科和山东省牟平县人民医院心理精神科。对象:选择2002-03/2004-04在北京回龙观医院精神科门诊和山东牟平人民医院心理精神科门诊或病房就诊的儿童多动症患儿60例,监护人均知情同意。随机分为2组,奥氮平组及哌醋甲酯组各30例。方法:奥氮平组患儿给予奥氮平2.5～7.5mg/d,晚上1次顿服;哌醋甲酯组给予哌醋甲酯5～15mg/d,分早、午2次口服。两组疗程均为12周。两组患儿于治疗前及治疗第12周末用Conners氏教师用量表(①多动指数项目分10个条目。②多动行为因子项目包括7个条目。每项表现为“无、稍有、相当多、很多”计为0,1,2,3分)、治疗副反应量表(分为行为毒性、化验异常、神经系统、植物神经系统、心血管系统及皮肤症状等。0无,1可疑或极轻,2轻度,3中度,4重度。最高分为22,最低为0,超过2分为阳性)进行多动症状及副反应评估。主要观察指标:两组患儿治疗第12周末多动症状评分及副反应评分。结果:60例患儿全部进入结果分析,无脱落。①两组患儿治疗第12周末多动症状评分比较:治疗12周后,奥氮平组及哌醋甲酯组患儿的多动指数总分及多动行为因子总分均较治疗前显著降低[12.4±2.8,15.1±9.2,13.7±3.4,20.8±10.3;26.6±3.9,43.5±11.7,25.5±4.8,41.6±5.9(t=8.16～15.26,P<0.05～0.01)];且奥氮平组的多动行为因子总分显著低于哌醋甲酯组(t=2.69,P<0.05)。②两组患儿治疗第12周末的副反应评分比较:奥氮平组、哌醋甲酯组患儿的副反应评分分别为10.3±4.5,10.9±3.8,差异无显著性意义(P>0.05)。结论:奥氮平及哌醋甲酯均能显著改善多动症患儿的多动症状和注意缺陷,但奥氮平对行为障碍的总体改善程度要优于哌醋甲酯。
Background: Attention deficit or hyperactivity disorders are commonly treated with psychotropic drugs, which have been shown to improve cognitive and behavioral disorders in most children. Objective: To compare the clinical efficacy and side effects of olanzapine with methylphenidate in children with ADHD. Design: Case comparison. Unit: Beijing Huilongguan Hospital Psychiatry and Muping County People’s Hospital of Shandong Province psycho-psychiatric. PARTICIPANTS: Sixty children with ADHD were selected from the Department of Psychiatry of Huilongguan Hospital in Beijing from March 2002 to April 2004 and the psychopsychiatric clinic or ward of Shandong Muping People’s Hospital. The guardians informed each other. Randomly divided into two groups, olanzapine group and methylphenidate group of 30 cases. Methods: The olanzapine group was given olanzapine 2.5 ~ 7.5mg / d, once a night serving Dayton; methylphenidate given methylphenidate 5 ~ 15mg / d, points early, afternoon 2 times orally. The two groups were treated for 12 weeks. Two groups of children before treatment and the end of treatment with Conners’s teacher scale (① multi-index index sub-item 10 ② multi-action factor program includes seven entries each performance as “no, slightly, Quite a lot, a lot of ”counted as 0,1,2,3 points), treatment side effects scale (divided into behavioral toxicity, laboratory abnormalities, nervous system, autonomic nervous system, cardiovascular system and skin symptoms, etc. 0 no, 1 Suspicious or very light, 2 mild, 3 moderate, 4 severe. The highest score was 22, the lowest was 0, more than 2 points were positive) for hyperactive symptoms and side effects assessment. MAIN OUTCOME MEASURES: At the end of the 12th week, two groups of children were treated with hyperactivity symptom score and side reaction score. Results: All the 60 children entered the result analysis without shedding. ①The scores of hyperactivity symptoms in the two groups at the end of the twelfth week were compared: the scores of hyperactivity index and hyperactive behavioral factors in the olanzapine group and the methylphenidate group after 12 weeks of treatment were significantly lower than those before treatment [12.4 ± 2.8,15.1 ± 9.2,13.7 ± 3.4,20.8 ± 10.3; 26.6 ± 3.9,43.5 ± 11.7,25.5 ± 4.8,41.6 ± 5.9 (t = 8.16 ~ 15.26, P <0.05 ~ 0.01)]; The total score of hyperactive behavioral factors in the flat group was significantly lower than that in the methylphenidate group (t = 2.69, P <0.05). ②Comparison of side reaction scores at the end of the 12th week in both groups: The adverse reaction scores in the olanzapine group and the methylphenidate group were 10.3 ± 4.5 and 10.9 ± 3.8, respectively, with no significant difference (P> 0.05 ). CONCLUSIONS: Both olanzapine and methylphenidate significantly improve hyperactivity and attention deficit hyperactivity disorder in children with ADHD, but olanzapine generally outperformed methylphenidate in behavioral disorders.