鹽酸托莫西汀治療兒童多動癥合并短暫性抽動障礙的臨床效果

景蘭　王毅　張文靜　田樂

[摘要] 目的 觀察兒童注意缺陷多動障礙（ADHD）合并短暫性抽動障礙應(yīng)用鹽酸托莫西汀治療的臨床研究。方法 采集2016年7月～2018年7月內(nèi)蒙古自治區(qū)精神衛(wèi)生中心門診治療的128例ADHD合并短暫性抽動障礙患兒，按不同治療方案分為兩組，每組64例。對照組服用鹽酸哌甲酯治療，觀察組服用鹽酸托莫西汀。比較兩組療效、認(rèn)知功能及不良反應(yīng)等多項(xiàng)指標(biāo)。 結(jié)果 治療2個(gè)月后，觀察組總有效率高于對照組（P < 0.05）;治療前兩組各項(xiàng)Cormer因子評分比較，差異無統(tǒng)計(jì)學(xué)意義（P > 0.05），治療后兩組各項(xiàng)Cormer因子評分均較治療前明顯降低（P < 0.05），且觀察組學(xué)習(xí)、行為、焦慮等因子評分低于對照組（P < 0.05）;治療前兩組運(yùn)動抽動、發(fā)聲抽動評分比較，差異無統(tǒng)計(jì)學(xué)意義（P > 0.05），治療后兩組運(yùn)動抽動、發(fā)聲抽動評分均較治療前降低（P < 0.05），且觀察組低于對照組（P < 0.05）;治療前兩組認(rèn)知功能各項(xiàng)因子評分比較，差異無統(tǒng)計(jì)學(xué)意義（P > 0.05）;治療后兩組認(rèn)知功能各項(xiàng)因子評分均較治療前升高（P < 0.05），且觀察組算數(shù)、編碼、數(shù)字廣度、C因子均高于對照組（P < 0.05）;觀察組不良反應(yīng)總發(fā)生率低于對照組（P < 0.05）。 結(jié)論 ADHD合并短暫性抽動障礙應(yīng)用鹽酸托莫西汀治療效果顯著，能有效改善ADHD，減輕抽動障礙，并糾正患兒認(rèn)知功能，提高臨床療效，且不良反應(yīng)少，安全有效。

[關(guān)鍵詞] 兒童多動性障礙;短暫性抽動障礙;鹽酸托莫西汀;鹽酸哌甲酯;C-WISC評分

[中圖分類號] R749.94? ? ? ? ? [文獻(xiàn)標(biāo)識碼] A? ? ? ? ? [文章編號] 1673-7210（2019）06（b）-0054-05

Clinical effect of Tomoxetine Hydrochloride for children with ADHD complicated by transient tic disorder

JIN Lan? ?WANG Yi? ?ZHANG Wenjing? ?TIAN Le▲

Department of Neurology， Inner Mongolia Mental Health Center， Inner Mongolia Autonomous Region， Huhhot? ?010020， China

[Abstract] Objective To observe the clinical treatment of children with attention deficit hyperactivity disorder （ADHD） complicated by transient tic disorder treated by Tomoxetine Hydrochloride. Methods The clinical data of 128 children with ADHD complicated by transient tic disorder who had received treatment in the Outpatient Service of Inner Mongolia Mental Health Center from July 2016 to July 2018 were enrolled in the study， and they were divided into two groups according to the different treatment options， with 64 cases in each group. The control group was treated with Methylphenidate Hydrochloride， whereas the observation group was treated with Tomoxetine Hydrochloride. The efficacy， cognitive function， adverse reactions and other indicators were compared between the two groups. Results The total effective rate of treatment in the observation group was higher than that in the control group after 2 months of treatment （P < 0.05）. There were no statistical differences in the Cormer factor scores between the two groups before treatment （P > 0.05）， however， these scores were lower than before treatment in both groups （P < 0.05）. The scores of learning， behavior， anxiety and other factors in the observation group were lower than those in the control group （P < 0.05）. Before treatment， there was no statistical difference between the two groups in the scores of exercise twitch and vocal twitch （P > 0.05）， these scores were reduced in both groups after treatment （P < 0.05）， and these scores in the observation group were lower than those in the control group （P < 0.05）. There were no statistical differences in the scores of cognitive function between the two groups before treatment （P > 0.05）; after treatment， however， the scores were increased than before treatment in both groups （P < 0.05）. The counting， coding， digital breadth， and C factor in the observation group were higher than those in the control group （P < 0.05）. The incidence of adverse reactions in the observation group was lower than that in the control group （P < 0.05）. Conclusion For children with ADHD complicated by transient tic disorder， Tomoxetine Hydrochloride is safe， effective and with significant curative effect， which can help improve ADHD， reduce tic disorder， correct cognitive function and enhance clinical efficacy， yet incurring fewer adverse reactions.

[Key words] Children with ADHD; Transient tic disorder; Atomoxetine Hydrochloride; Methylphenidate Hydrochloride; C-WISC score

兒童注意缺陷多動障礙亦稱為多動癥（attention deficit hyperactivity disorder，ADHD）是一種神經(jīng)發(fā)育障礙，是兒童最常見的行為障礙，發(fā)病率高達(dá)3%～10%，以早產(chǎn)兒童居多。多動癥兒童的智力普遍正常，但存在情緒、行為、學(xué)習(xí)障礙，通常表現(xiàn)在活動過度、注意力集中困難、情緒任性或沖動、學(xué)習(xí)困難、品行障礙及神經(jīng)系統(tǒng)發(fā)育異常[1]。此外，多動癥兒童易伴發(fā)抽動障礙，臨床表現(xiàn)出突發(fā)、快速、重復(fù)、刻板、不自主、非節(jié)律性等特征的發(fā)聲抽動、單一或多部位的肌肉運(yùn)動抽動，以短暫性抽動障礙較多，為5%～24%[2]。中樞興奮劑是目前國內(nèi)治療多動癥的一線藥物，以哌甲酯及其控釋片為主，療效顯著，在臨床應(yīng)用廣泛。但是，相關(guān)研究表示，中樞興奮劑有較多藥物反應(yīng)，并能誘發(fā)或加重抽動癥狀，且存在藥物濫用的問題，故藥物存在爭議[3]?！?br>