抗抑郁治療聯合心理行為干預對治療腸易激綜合征作用的研究

明平良 石勝利 馮 進 盧月云

[摘要] 目的 探討抗抑郁治療聯合心理行為干預治療腸易激綜合征的作用。方法 選擇IBS患者105例,隨機分成對照組(常規治療加匹維溴胺)、抗抑郁組(對照組治療基礎上加黛力新)和干預組(抗抑郁組治療基礎上給予綜合心理行為干預),比較三組治療前后SCL-90評分、癥狀評分以及療效。結果 干預組患者的SCL-90評分、癥狀評分顯著低于對照組和抗抑郁組(P<0.05),療效也顯著優于其余兩組(P<0.05)。結論 抗抑郁治療聯合心理行為干預可顯著改善患者精神狀態,明顯提高療效。

[關鍵詞] 腸易激綜合征;心理因素;心理行為干預;抗抑郁藥

[中圖分類號] R574.4[文獻標識碼] A[文章編號] 1004-8650(2009)06-017-02

Research of antidepressant combined with psychological behavior intervention treatment on irritable bowel syndrome

MING Ping-liang1,SHI Shen-li2,FENG jin1,LU Yue-yun1

(1.Department of Medical,8730th Hospital of Chinese People's Armed Police Forces,Guangzhou 510800,Guangdong Province,China;2. Department of Gastroenterology,First People's Hospital,Guangzhou 528421,Guangdong Province,China)

[Abstract] Objective To study the effect of antidepressant combined with psychological behavior intervention treatment on patients with irritable bowel syndrome(IBS). Methods One hundred and five patients with IBS were rendomly divided into control group(routine method+pinaverium bromideand),antidepressant group(routine method+pinaverium bromide+antidepressant)and intervention group(routine method+pinaverium bromide+antidepressant+psychological behavior intervention).The factor scores of SCL-90, symptom scores and efficacy were compared before and after the treatment.Results In intervention group,most factor scores of SCL-90 and symptom scores were abviously lower than control group and antidepressant group(P<0.05).Compared with the other two groups,the efficacy of intervention group was significantly improved(P<0.05). Conclusion Antidepressant combined with psychological behavior intervention can improve the patients'state of mood significantly, and also increase the efficacy abviously.

[Key words] irritable bowel syndrome; psychological factors; psychological behavior intervention; antidepressant

腸易激綜合征(IBS)是臨床常見的功能性胃腸病,該病在歐美國家人群患病率為10%-20%,亞洲國家發病率約為5%[1]。其發病機制與飲食、腸道炎癥、胃腸動力改變、內臟感覺異常以及腦-腸軸的改變等多種綜合因素有關,特別是抑郁、焦慮和軀體化等多種精神心理因素與IBS的關系,近年逐漸受到重視。我們對105例IBS患者進行抗抑郁治療聯合心理行為干預,取得了良好療效,現報道如下。

1對象與方法

1.1對象

2006年8月-2009年3月在本院診治并符合IBS 羅馬Ⅲ診斷標準的患者105例,男42例,女63例,年齡18-64歲,平均(41±15)歲,其中腹瀉型51例,便秘型33例,腹瀉便秘交替型14例,未定型7例。入組標準:①患者知情同意并具有配合能力;②經內鏡、X線、B 超和實驗室檢查排除腸道器質性疾病者;③近2周未服用IBS藥物。排除標準:①精神疾病患者;②孕婦和哺乳期婦女;③伴有其他器官疾病,如胰腺炎、吸收不良綜合征、糖尿病、甲亢及乳糖不耐受癥等,影響IBS診斷和治療者;④近2月服用精神類藥物或不能耐受抗抑郁藥者。……