| 崔征,侯鹏飞,刘伟.氟哌噻吨美利曲辛联合认知行为疗法治疗癔球症 91例分析[J].安徽医药,2022,26(6):1244-1249. |
| 氟哌噻吨美利曲辛联合认知行为疗法治疗癔球症 91例分析 |
| Analysis of flupentixol and melitracen combined with cognitive behavior therapy in the treatment of 91 cases of globus sensation |
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| DOI：10.3969/j.issn.1009-6469.2022.06.044 |
| 中文关键词: 转换障碍 认知疗法 行为疗法 氟哌噻吨 美利曲辛 食管括约肌，上段 癔球症 |
| 英文关键词: Conversion disorder Cognitive therapy Behavior therapy Flupentixol Melitracen Esophageal sphincter, upper Globus sensation |
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| 中文摘要: |
| 目的探讨氟哌噻吨美利曲辛联合认知行为疗法治疗癔球症的临床价值。方法选择 2017年 9月至 2019年 8月濮阳市油田总医院收治的 182例癔球症病人，按随机数字表法分为对照组与观察组，每组 91例，两组均给予认知行为疗法，在此基础上对照组采用埃索美拉唑、莫沙必利等抑酸、促动力学治疗，观察组在对照组基础上加用氟哌噻吨美利曲辛治疗，比较两组治疗前后癔球症症状评分量表( GETS)的变化，采用焦虑自评量表( SAS)、抑郁自评量表( SDS)及匹兹堡睡眠质量指数( PSQI)评定病人心理状态及睡眠质量的变化；并采用胃肠动力学测定仪进行食管上括约肌运动功能；采血测定治疗前后神经肽 Y、P物质、降钙素基因相关肽( CGRP)等脑肠肽指标的变化；比较两组治疗不良反应发生情况；并采用 Pearson相关性分析评估癔球症病人 GETS评分与食管上括约肌运动功能指标的相关性。结果治疗 12周，两组 GETS表、 SAS表、 SDS表、 PSQI评分均降低(P<0.05)观察组降低幅度［( 6.36±2.11)分、(46.63±5.14)分、(44.52±4.15)分、(4.71±0.65)分］高于对照组［( 9.26±3.05)分、(49.06±3.75)，分、(48.14±3.97)分、(5.23±0.78)分］(P<0.05)；治疗 12周，两组食管上括约肌静息压降低( P<0.05)，观察组静息压 |
| 英文摘要: |
| Objective To explore the clinical value of flupentixol and melitracen combined with cognitive behavior therapy in thetreatment of globus sensation.Methods A total of 182 patients with globus sensation admitted to Puyang Oilfield General Hospitalfrom September 2017 to August 2019 were recruited as the study subjects. They were divided into control group and observation groupby the random number table method, with 91 cases in each group. Both groups of patients were given cognitive behavioral therapy. Onthis basis, patients in the control group were treated with esomeprazole, mosapride and other acid-suppressive and prokinetic treatments. The observation group were treated with flupentixol and melitracen on the basis of the treatments for control group. Changes inthe Glasgow Edinburgh Throat Scale (GETS) scores of the 2 groups before and after treatment were compared. The Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS) and Pittsburgh Sleep Quality Index (PSQI) were used to assess changes in patients' psychological status and sleep quality. The gastrointestinal kinetics measuring instrument was used to measure the motor function of upperesophageal sphincter. Blood samples were collected to determine changes in brain-gut peptide indexes such as neuropeptide Y (NPY), substance P (SP) and calcitonin gene-related peptide (CGRP) before and after treatment. The incidence rates of adverse reactions in the2 groups were compared. Pearson correlation analysis was used to evaluate the correlation between the GEST score and motor functionindex of superior esophageal sphincter in patients with globus sensation.Results After 12 weeks of treatment, GETS, SAS, SDS and PSQI scores of both groups were decreased (P<0.05), and the decreases of the observation group [(6.36 ± 2.11) points, (46.63 ± 5.14)points, (44.52 ± 4.15) points, (4.71 ± 0.65) points] were larger than those of the control group [(9.26 ± 3.05) points, (49.06 ± 3.75)points, (48.14 ± 3.97) points, (5.23 ± 0.78) points] (P<0.05). After 12 weeks of treatment, upper esophageal sphincter resting pressure was decreased in both groups (P<0.05), and resting pressure of the observation group was lower than that of the control group [(52.25 ± 10.65) mmHg vs. (57.85 ± 9.63) mmHg] (P<0.05). After 12 weeks of treatment, NPY was increased, while SP and CGRP were de creased in both groups (P<0.05). SP and CGRP in observation group [(665.14 ± 98.52) ng/L, (181.15 ± 23.63) ng/L] were lower thanthose in the control group [(750.63 ± 49.87) ng/L, (210.89 ± 16.25) ng/L], and NPY was higher than that in the control group [(780.25 ±30.06) ng/L vs. (706.25 ± 50.14) ng/L] (P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the 2 groups (8.79% vs. 7.69%) (P>0.05). GEST score was positively correlated with upper esophageal sphincter resting pressure of patients with globus sensation (r=0.46, P<0.05).Conclusions Flupentixol and melitracen combined with cognitive behaviortherapy can not only improve the symptoms of patients with globus sensation and relieve anxiety and depression but also improve patients' sleep quality and reduce the resting pressure of upper esophageal sphincter as well as adjust the balance of brain-gut peptide axis. Besides, the treatment method is safe and effective. |
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