【關鍵詞】 難治性強迫症；思瑞康；氟西汀
［摘要］ 目的 探討思瑞康合併氟西汀治療難治性強迫症的療效。方法 選擇2005年3月~2006年5月於我科門診及住院治療的難治性強迫症患者70例，按就診及確診順序編號，單號爲觀察組（n=36），雙號爲對照組（n=34）。對照組給予氟西汀治療，劑量20 mg, 每天早晨1次，口服。以病情逐漸加量，7~14天加至治療量。觀察組除給氟西汀治療外，同時合併思瑞康治療，思瑞康起始量100 mg/d,以每週100~200 mg,逐漸增加劑量，日劑量範圍200~600 mg。療程爲8周。採用耶魯布朗強迫量表評定患者的`強迫程度，包括10項症狀，每項症狀採用5級評分，總分=各項目評分之和。分別於治療前及治療後2、4、6、8週末評定1次，一次評定15~20 min。組間比較採用t檢驗。結果 納入觀察組36例，對照組34例，分別脫落6例、4例，脫落病例均爲不能及時複查和進行心理檢驗者。剩餘觀察組30例，對照組30例，患者均完成定期的複診和心理測驗，量表檢測均經檢驗符合要求，進入結果分析，（1）兩組治療前後耶魯布朗強迫量表總分結果：觀察組從第2週末起耶魯布朗強迫量表評分與治療前相比差異有顯著性 （P＜0.05），對照組第4週末耶魯布朗強迫量表評分與治療前比較差異有非常顯著性 （P＜0.01）。（2）兩組間在4週末、6週末、8週末耶魯布朗強迫量表評分值比較差異具有顯著性或非常顯著性 （P＜0.05或P＜0.01）；（3）在第4週末對照組副作用高於觀察組，差異有顯著性（P＜0.05）。結論 小劑量思瑞康可作爲常規的增效劑治療難治性強迫症。
［關鍵詞］ 難治性強迫症；思瑞康；氟西汀
Comparative study on the efficacy of combining seroquel and fluoxetine in treatment of refractory obsessive-compulsive disorder
［Abstract］ Objective To explore the efficacy of combining seroquel and fluoxetine in the treatment of refractory obsessive-compulsive ods Seventy refractory obsessive-compulsive patient,who were treated at the psycho out-patient clinic of First Hospital,Xi’an Jiaotong University,October 2005 to May 2006. There were numbered by the order of visiting and diagnosing,the patients with single numbers were considered as study group （n=36） and those with even number was control group （n=34）. The patients in the control group were treated with 20 mg fluoxetine,once a day in the morning,taking dosage was increased gradually according to patient’s condition,and add to the treatment dosage after 7~14 days. Those in the study group were treated with 20 mg fluoxetine integrated with seroquel,fluoxetine dosage was begun from 100 mg a day,and was increased according to 100 mg to 200 mg a week,a day’s dosage limited in 200 mg to 600 progress was 8 weeks. Obsessive-compulsive level of patients was evaluated with Yale-Brown Obessive-CompulsiveScal（Y-BOCS）,Obsessive-compulsive level of patients in the two groups was assessed before treatment and after treatment for 8 weeks,once for 15~20 arison of the two groups was performed with t lts Six and four patients in the study group with 36 patients and control group 34 patients were dropped,respectively, because they could not conduct reviews and detection. At Thirty patients in the study group and 30 patients in control group were all conducted regular reviews and psychological detection. The results of scale were all accorded with the criteria,and they were involved in the result analysis.（1）General scores of YBOCS before and after treatment in the two scales of YBOCS in study group were significantly at the second weekend than before treatment （P＜0.05）. The scales of YBOCS in control group were significantly higher at the 4.（2）The scales