目的 研究喹硫平联合曲唑酮治疗重度抑郁症的临床效果。方法 收集2012年6月—2014年6月在北京市门头沟龙泉医院住院及门诊重度抑郁症患者104人,采用随机数字法将患者随机分为治疗组和对照组,每组各52人。对照组口服盐酸曲唑酮片,100 mg/d起始,2周内加至充分治疗剂量300～400 mg/d。治疗组在对照组的基础上同时口服富马酸喹硫平片,从100 mg/d起,1周内增加剂量至300 mg/d,并根据病情调整剂量,最高剂量400 mg/d。两组患者疗程均为8周。分别在患者入组时及治疗4、8周末进行汉密尔顿抑郁量表(HAMD)(24项版)、药物副作用量表(TESS)评估。结果 对照组和治疗组的总有效率分别为78.84%、90.38%,两组比较差异有统计学意义(P < 0.05)。与治疗前比较,治疗组4、8周末HAMD总分显著降低(P < 0.01),对照组8周末HAMD总分明显降低(P < 0.05)。与对照组治疗后比较,治疗组治疗前及治疗4周末HAMD总分无明显变化,8周末HAMD总分显著降低(P < 0.01)。与治疗前比较,治疗组4周末焦虑躯体化、睡眠障碍评分差异均有统计学意义(P < 0.05),治疗8周末焦虑躯体化、认识障碍、睡眠障碍、绝望感评分差异显著(P < 0.01),而对照组只有焦虑躯体化评分在治疗8周末的变化有统计学意义(P < 0.05)。与对照组比较,治疗组治疗8周末焦虑躯体化、认识障碍、睡眠障碍、绝望感评分明显降低,差异显著(P < 0.01)。结论 富马酸喹硫平片联合盐酸曲唑酮片是治疗重度抑郁症有效且相对较安全的方法,值得临床推广应用。

Objective To explore the clinical efficacy of quetiapine combined with trazodone in treatment of severe depression. Methods The patients with severe depression (104 cases) from inpatients and outpatients of Beijing Mentougou District Longquan Hospital from June 2012 to June 2014 were randomly divided into control and treatment groups, and each group had 52 cases. The patients in the control group were po administered with Trazodone Hydrochloride Tablets, started from 100 mg/d to full amounts of treatment 300 — 400 mg/d during two weeks. The patients in the treatment group were po administered with Quetiapine Fumarate Tablets on the basis of the treatment in the control group, started from 100 mg/d to 300 mg/d during one week, and even the highest dose 400 mg/d was adopted according to the condition of the patient dose. Both groups were treated for 8 weeks. Hamilton Depression Scale (HAMD) (24 items) and Treatment Emergent Symptom Scale (TESS) of adverse reactions were evaluated before treatment and treated for 4 and 8 weeks. Results After treatment, the total effective rate of control and treatment groups were 78.84% and 90.38%, respectively, and there were differences between two groups (P < 0.05). Compared with those before treatment, HAMD scores in treatment group treated for 4 and 8 weeks were significantly reduced (P < 0.01), while control group treated for 8 weeks was significantly reduced (P < 0.05). Compared with control group after treatment, HAMD scores of treatment group before treatment and treated for 4 weeks had no significant difference, but those of treatment group treated for 8 weeks were significantly reduced (P < 0.05). Scores of somatization disorder and sleep disorders in treatment group treated for 4 weeks were improved significantly compared with those of before treatment, and the difference was significant (P < 0.05). And scores of somatization disorder, cognitive disorder, sleep disorders, and hopelessness in treatment group treated for 8 weeks were improved significantly (P < 0.01). There was significant difference for scores of somatization disorder in treatment group treated for 4 weeks (P < 0.05). Compared with control group after treatment, scores of somatization disorder, cognitive disorder, sleep disorders, and hopelessness of treatment group treated for 8 weeks were significantly reduced with significant difference (P < 0.01). Conclusion Quetiapine Fumarate Tablets combined with Trazodone Hydrochloride Tablets is effective and safe relatively in treatment of severe depression, which is worth clinical promotion.