目的 探討喹硫平聯(lián)合氯硝西泮治療老年躁狂癥的臨床療效及其對血清去甲腎上腺素（NE）、五羥色胺（5-HT）、多巴胺（DA）水平的影響。方法 選取2018年1月-2019年4月石家莊市第八醫(yī)院老年躁狂癥患者117例作為研究對象，根據(jù)治療方案不同將患者分為對照1組、對照2組、觀察組，每組各39例。對照1組口服富馬酸喹硫平片，起始劑量為25 mg/次，2次/d，每隔1~3 d增加25 mg，最大劑量300~600 mg/d，分2~3次服用。對照2組口服氯硝西泮片，1 mg/d。觀察組采用富馬酸喹硫平片聯(lián)合氯硝西泮片治療，用法用量同對照1組、對照2組。3組均持續(xù)治療8周。觀察3組患者的臨床療效，同時比較3組的貝克-拉范森躁狂量表（BRMS）評分、陽性與陰性癥狀量表（PANSS）評分、及NE、5-HT、DA、白細胞介素（IL）-2、IL-1β、腫瘤壞死因子（TNF）-α的水平。結(jié)果 治療后，觀察組總有效率為94.87%，顯著高于對照1組的76.92%和對照2組的74.36%（P<0.05）。治療2、4、6、8周后，3組BRMS評分和PANSS評分均顯著降低（P<0.05）；且觀察組BRMS評分和PANSS評分顯著低于同期對照1組、對照2組（P<0.05）。治療8周后，3組血清5-HT、NE、DA、IL-2、IL-1β和TNF-α水平均顯著降低（P<0.05）；且觀察組血清5-HT、NE、DA、IL-2、IL-1β和TNF-α水平較同期對照1組、對照2組顯著降低（P<0.05）。結(jié)論 喹硫平聯(lián)合氯硝西泮治療老年躁狂癥患者的療效顯著，在提高神經(jīng)遞質(zhì)因子水平、抑制炎性反應(yīng)方面具有顯著優(yōu)勢，可進一步緩解患者躁狂程度，減輕臨床癥狀，且具有一定安全性，值得臨床推廣。

Objective To explore the effect of quetipine combined with clonazepam on senile patients with mania, and its effect on serum levels of NE, 5-HT, and DA. Methods A total of 117 elderly patients with mania in the No.8 Hospital of Shijiazhuang from January 2018 to April 2019 were selected as the research subjects. According to different treatment regimens, the patients were divided into control group 1, control group 2 and observation group, with 39 cases in each group. Patients in the control group 1 were po administered with Quetiapine Fumarate Tablets, the initial dose was 25 mg/time, twice daily, 25 mg was added every 1 to 3 days, and the maximum dose was 300 to 600 mg/d, divided into 2-3 times. Patients in the control group 2 were po administered with Clonazepam Tablets, 1 mg/d. Patients in the observation group was treated with Quetiapine Fumarate Tablets and Clonazepam Tablets, and the usage and dosage were the same as control group 1 and control group 2. All three groups were treated for 8 weeks. The clinical efficacy of three groups was observed, and the levels of NE, 5-HT, DA, IL-2, IL-1β and TNF-α were compared among three groups. Results After treatment, the total effective rate of observation group was 94.87%, which was significantly higher than that of control group 1 (76.92%) and control group 2 (74.36%) (P<0.05). After 2, 4, 6 and 8 weeks of treatment, the BRMS score and PANSS score in 3 groups were significantly decreased (P<0.05), and BRMS score and PANSS score of observation group were significantly lower than those of control group 1 and control group 2 at the same period (P<0.05). After 8 weeks of treatment, the serum levels of 5-HT, NE, DA, IL-2, IL-1β and TNF-α in three groups were significantly decreased (P<0.05), and the levels of 5-HT, NE, DA, IL-2, IL-1β and TNF-α in observation group were significantly decreased compared with control group 1 and control group 2 at the same period (P<0.05). Conclusion Quetipine combined with clonazepam has significant efficacy in treatment of elderly patients with mania, with significant advantages in improving the level of neurotransmitter factors and inhibiting inflammatory response, which can further alleviate the manic degree of patients and reduce clinical symptoms. Moreover, quetipine combined with clonazepam has certain safety and is worthy of clinical promotion.

R971