氟哌啶醇联用穴位敷贴可乐定治疗儿童抽动症的疗效观察_李建军.pdf

114Clinical Research,Mar.2023,Vol.31 No.03作者简介：李建军，男，主治医师，本科，研究方向：小儿神经系统疾病。中西医结合治疗氟哌啶醇联用穴位敷贴可乐定治疗儿童抽动症的疗效观察李建军，闫江涛，高峰，樊亚妮，宋虎杰(西安中医脑病医院 脑病十一科，陕西 西安 710068)摘要：目的 比较氟哌啶醇联用心俞穴、肝俞穴贴敷可乐定透皮贴治疗儿童抽动症的疗效。方法 选取西安中医脑病医院门诊与住院抽动症患儿 64 例，使用随机数字法分为试验组(32 例)和对照组(32 例)，对照组用氟哌啶醇常规治疗，初始服用剂量为 1 mg/次，1 次/d，7 d 后可逐渐增量至 2 mg/次，同时口服维生素 B6 2 mg/(kgd)，以减轻氟哌啶醇副作用。试验组在对照组基础上于心俞穴和肝俞穴贴敷可乐定透皮贴，根据患儿体重选取药物剂量，选用1 mg/片及 1.5 mg/片，交替循环贴敷心俞穴、肝俞穴，四周为 1 疗程。两组患儿均连续治疗 3 个月。比较两组患儿治疗前后耶鲁综合抽动严重程度量表(YGTSS)得分，治疗有效率，中医证候积分，观察治疗过程中的药物不良反应。结果 治疗 3 个月后，两组患儿 YGTSS 评分均低于治疗前，差异具有统计学意义(P 0.05)，且试验组 YGTSS 评分低于对照组，差异具有统计学意义(P 0.05)。试验组治疗有效率(90.60%)高于对照组(68.81%)，差异有统计学意义(P 0.05)。治疗 3 个月后，两组患儿中医症候积分均显著低于治疗前，且试验组中医症候积分低于对照组，差异有统计学意义(P 0.05)。两组不良发生率分别为 12.5%(4/32)和 9.4%(3/32)，差异无统计学意义(P 0.05)。结论 儿童抽动症患者于心俞穴和肝俞穴可加用可乐定透皮贴较单用氟哌啶醇临床疗效显著，且易于操作，在治疗过程中不会增加不良反应，值得临床应用。关键词：儿童抽动症；氟哌啶醇；穴位贴敷；可乐定透皮贴片；临床疗效 中图分类号：R729文献标志码：B DOI：10.12385/j.issn.2096-1278(2023)03-0114-04Clinical Observation of Haloperidol Combined with Acupoint Application of Clonidine in the Treatment of Tourette Syndrome in ChildrenLI Jianjun,YAN Jiangtao,GAO Feng,FAN Yani,SONG Hujie(Eleven Departments of Encephalopathy,Xian Encephalopathy Hospital of Traditional Chinese medicine,Xian Shaanxi 710068,China)Abstract:Objective To compare the clinical efficacy of Haloperidol plus Clonidine transdermal patch on Xinshu and Ganshu points in the treatment of children with Tourette syndrome.Methods A total of 64 children with TIC syndrome were selected from the outpatients and inpatients of Xi an Hospital of Traditional Chinese Medicine and divided into an experimental group(32 cases)and a control group(32 cases)by random number method.The control group was given routine treatment with haloperidol,the initial dose was 1 mg/time,once/d,and gradually increased to 2 mg/time 7 days later.Meanwhile,vitamin B6 was taken orally at 2 mg/(kgd)to reduce the side effects of haloperidol.In the experimental group,a clonidine transdermal patch was applied to Xinshu point and Ganshu point on the basis of the control group.The drug dosage was selected according to the weight of the children,1 mg/tablet and 1.5 mg/tablet were used to apply alternately to Xinshu point and Ganshu point,and the four weeks was a course of treatment.Both groups were treated continuously for 3 months.The Yale Gross Tic Severity Scale(YGTSS)score,treatment effective rate,and TCM syndrome score before and after treatment were compared between the two groups,and adverse drug reactions during treatment were observed.Results After 3 months of treatment,the YGTSS score of the two groups was lower than that before treatment,and the difference was statistically significant(P 0.05),and the YGTSS score of the experimental group was lower than that of the control group,and the difference was statistically significant(P 0.05).The effective rate of the experimental group(90.60%)was higher than that of the control group(68.81%),and the difference was statistically significant(P 0.05).After 3 months of treatment,the TCM syndrome score of the two groups was significantly lower than that before treatment,and the TCM syndrome score of the experimental group was lower than that of the control group,and the difference was statistically significant(P 0.05).The incidence of adverse events in the two groups was 12.5%(4/32)and 9.4%(3/32),respectively,with no statistical significance(P 0.05).Conclusion The clinical efficacy of the Clonidine transdermal patch on Xinshu and Ganshu points is more effective and easy than that of haloperidol alone,and it does not increase the adverse reactions of treatment,which is worthy of clinical promotion.Key Words:the children with Tourette syndrome;haloperidol;acupoint application;clonidine transdermal patch;clinical efficacy儿童抽动症，是一类好发于 3 14 岁儿童的精神障碍性疾病，主要临床表现为不定期的肌肉无节奏抽搐及抽搐过程中伴随性的喉部发声，抽动症常并发注意缺陷多动症，学习困难、睡眠障碍等，患儿临床表现多伴有情绪不稳定，对其健康成长及正常的社交与日常活动产生不利影响1-2。近年来，随着手机、电脑等电子产品的普及，儿童抽动症的发病率呈逐年递增趋势，发病率高达 40，男性儿童比女性儿童具有更高的发病风险3。目前，对于儿童抽动症患者，临床多使用口服药物进行治疗，但存在治疗周期长、治疗效果不理想及停药后症状反复等问题。在药物方面，临床较为常用的是氟哌啶醇，这类药物可以帮助患者抵抗幻觉妄想、兴奋躁动，稳定115临床研究 2023 年 03 月第 31 卷第 03 期情绪。虽然在短期内，拥有显著效果，但是治疗多动症效率仍然十分低下4，因此寻找更有效的治疗方案对于儿童抽动症的治疗尤其重要。可乐定透片主要成分为可乐定，在治疗儿童抽动症上具有良好的作用5-6。从中医辨证的角度认为该病与“慢惊风”“瘛疭”“筋惕”等因素有关，病位主要在心、肝二脏7。本研究在氟哌啶醇用药的基础上再用心俞穴、肝俞穴贴敷可乐定贴片辅助治疗抽动症，临床实践过程中取得了较好疗效，现报道如下。1资料与方法1.1两组患儿一般情况比较64 例患儿均来自西安中医脑病医院门诊与住院患儿，按照随机抽样的方式进行分组，其中对照组和试验组每组各 32 例。对照组男 23 例，女 9 例；年龄 6 14 岁，病程 3 个月 4 年；短暂性抽动障碍、慢性抽动障碍和Tourette 综合征分别为 2 例、26 例和 4 例；病情轻度和中重度分别为 24 例和 8 例。试验组男童 22 例，女童 10 例；年龄 6 13 岁，病程 8 个月 4 年；短暂性抽动障碍，慢性抽动障碍和Tourette综合征分别为3例、24例和5例；轻度和中重度组分别为 25 例和 7 例。两组基线资料比较差异无统计学意义(P 0.05)。见表 1。本研究经本院伦理委员会的批准，且所有患者均在患儿家长的知情同意后纳入。表 1两组患儿一般情况比较 n(%)，sx 组别例数性别平均年龄/岁 平均病程/年疾病类型病情程度男女短暂性抽动障碍慢性抽动障碍Tourette 综合征轻度中重度对照组3223(71.88)9(28.12)8.651.721.970.492(6.25)26(81.25)4(1.25)24(75.00)8(25.00)试验组3222(68.75)10(31.25)8.461.731.800.423(9.38)24(75.00)5(15.62)25(78.13)7(21.87)2/t0.0720.4931.4610.3920.094P0.0670.0720.0960.8700.7901.2纳入与排除标准纳入标准：相关的患儿经过诊断确定有抽动症，并且符合美国精神障碍诊断与统计手册(第 5 版)中的诊断标准8；患儿智力正常，除多动症外，无其他精神类或者是情绪类