Objective To explore the efficacy,onset time and safety of naloxone plus olanzapine on patients with senile delirium. Methods We enrolled 66 patients with senile delirium from Zhejiang Xiaoshan Hospital from January 2010 to October 2013 and randomly divided them into experimental group ( n =33 ) and control group ( n =33 ). The subjects were given appropriate treatment according to their pathogeny,based on which the two groups were given different interventions. The experimental group was administrated with olanzapine with an initial dose of 1. 25-2. 50 mg/d and an adjusted range of 1. 25-10. 00 mg/d and was given 100 ml of 0. 9% sodium chloride solution plus 0. 8 mg of naloxone in the way of intravenous drip for one time per day. The control group was only given oral or sublingual administration of olanzapine with an initial dose of 1. 25-2. 50 mg/d and an adjusted range of 1. 25-10. 00 mg/d. Before intervention,from day 1 to day 7 during treatment,CGI-SI and CGI-GI were used to evaluate the severity of dysphrenia and the alleviation status of the subjects. When the reduction in CGI-SI baseline score during the observation period was ≥1,the dosage and time then were taken as onset dosage and onset time. During the observation period,the DRS-R-98 score of the subjects were assessed by consultant doctors. Results The control group had 29 subjects who finished the whole intervention,for 3 subjects discharged and 1 subjects was transferred to ICU for breathing machine;the experimental group had 32 subjects that finished the intervention,for 1 subject discharged. The two groups were not significantly different(P>0. 05)in CGI-SI score before the intervention;the experimental group was lower (P<0. 05)than the control group in CGI-SI score after the intervention;the two groups both had lower CGI-SI score after treatment than that before treatment. After the intervention,the effective rate of the control group was 69. 0%(20/29),lower (χ2 =6. 60,P<0. 05)than that of the experimental group,which was 96. 9%(31/32). The experimental group was lower (P<0. 05)in onset dosage and earlier(P <0. 05)in onset time than the control group. There was significant interaction between the two groups and between different time points in DRS-R-98 score;for the comparison between the two groups,the experimental group was lower ( P <0. 05 ) than the control group in DRS -R -98 score between day 2 and day 5;for the comparison between different time points,the control group had lower(P<0. 05)DRS-R-98 score between day 3 and day 7 than that before the intervention,and the experimental group had lower(P<0. 05)DRS-R-98 score between day 2 and day 7 than that before the intervention. No subjects who discontinued for severe adverse reaction to the drugs were noted during observation period. Conclusion Naloxone joint olanzapine are effective and efficient in the treatment of senile delirium. The usage of olanzapine in this therapy be safe due to the small dosage.%目的：探讨纳洛酮联合奥氮平治疗老年谵妄的疗效、起效时间及安全性。方法选取2010年1月—2013年10月在浙江萧山医院住院期间发生老年谵妄的患者66例，采用随机数字表法将患者分为试验组和对照组，各33例。两组均根据谵妄病因给予针对性治疗，试验组在此基础上给予奥氮平治疗，起始剂量1.25～2.50 mg/d，之后剂量在1.25～10.00 mg/d调整，同时给予0.9％氯化钠溶液100 ml＋纳洛酮0.8 mg，静脉滴注，1次/d。对照组给予奥氮平口服或舌下含服治疗，起始剂量1.25～2.50 mg/d，之后剂量在1.25～10.00 mg/d调整。分别在两组患者治疗前、治疗第1～7天，以临床总体印象量表（ CGI-SI、CGI-GI）分别评价患者精神障碍严重程度及症状改善情况，并将观察期内CGI-SI基线分减少≥1分时用药剂量及时间分别作为起效剂量和起效时间。在观察期内由会诊医生评定患者谵妄分级量表-98修订版（DRS-R-98）评分。结果对照组因自动出院脱落3例，转ICU插管上呼吸机治疗脱落1例，共完成29例；试验组因自动出院脱落1例，共完成32例。两组治疗前CGI-SI评分比较，差异无统计学意义（P＞0.05）；试验组治疗后CGI-SI评分低于对照组（P＜0.05）；两组治疗后CGI-SI评分均较治疗前降低（P ＜0.05）。治疗后，对照组显效率为69.0％（20/29），低于试验组的96.9％（31/32）（χ2＝6.60，P＜0.05）。试验组起效剂量低于对照组，起效时间短于对照组（ P＜0.05）。两组治疗前后DRS-R-98评分时间与组间存在交互作用（ P＜0.05）；组间比较：两组治疗第2～5天，试验组DRS-R-98评分均低于对照组（ P＜0.05）；不同时间点比较：对照组治疗第3～7天DRS-R-98评分均低于治疗前，试验组治疗第2～7天DRS-R-98评分均低于治疗前（ P＜0.05）。两组在观察期内均无因严重的药物不良反应而中断治疗者。结论纳洛酮联合奥氮平治疗老年谵妄起效快、疗效好，奥氮平的起效剂量低，使用剂量小，安全性高。
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