目的探讨奥氮平直肠给药对老年缺血性卒中后患者谵妄的治疗效果及安全性。 方法采用前瞻性研究的方法，将解放军总医院第一附属医院干二科2013年3月1日～2014年2月18日收治的60例缺血性卒中后谵妄的住院患者分为口服给药组及直肠给药组。两组患者均在谵妄发生后24 h内给予奥氮平治疗。用药前及用药1周后对两组均进行谵妄评定量表（Confusion Assessment Method， CAM）及美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分分别评估两组患者用药前及用药后的谵妄严重情况及卒中严重程度。比较两组患者用药治疗1周后的用药平均剂量、治疗效果及副作用等。3个月后对两组患者进行改良Rankin量表（modified Rankin Scale，mRS）评分随访以评估药物治疗是否影响缺血性卒中患者的预后。 结果①口服给药和直肠给药两组患者年龄、性别、1周内NIHSS及CAM得分差异均无显著性：NIHSS中位数（8.5 vs 10；P=0.79）、CAM[（25.8±3.1）vs（26.1±5.3）；P=0.79]；两组患者合并高血压病、糖尿病、冠状动脉粥样硬化性心脏病比例差异无显著性：高血压病（6.7% vs2.0%；P=0.18）、糖尿病（10.0% vs 23.3%；P=0.17）、冠状动脉粥样硬化性心脏病（50.0% vs 60.0%；P=0.43）；两组患者缺血性卒中部位比较差异无显著性（P=0.76）。②口服给药和直肠给药两组均未发生明显副作用。直肠给药组1周内平均给药剂量明显低于口服给药组[（5.33±2.12）vs（4.25±2.06）；P=0.03]。③用药1周后，直肠给药组CAM、NIHSS评分均明显低于口服给药组：CAM[（19.8±3.9）vs（15.2±2.1）；P=0.00]、NIHSS中位数（7.5 vs 6.5；P=0.00）。3个月后随访mRS得分提示两组之间差异无显著性（P=0.15）。 结论老年缺血性卒中后谵妄患者，尤其是口服给药困难者，直肠给药可能是一种较安全有效的替代方式，但用药剂量尽量小于口服给药剂量。%Objective To investigate the effectivity and safety about olanzapine administered rectally for ischemic stroke old patients. Methods Sixty patients (aged≥65 years) admitted to the Department of Cardre Ward-2 of the First Afifliated Hospital of the General Hospital of People's Liberation Army (PLA) from March 2013 with delirium after a recent stroke was accepted. All these 60 patients were randomly divided into two groups to accept with olanzapine orally or rectally, respectively. All the patients fuliflled the National Institutes of Health Stroke Scale (NIHSS) and the Confusion Assessment Method (CAM) scale before and one week after they used the drug of olanzapine. Compare the baseline data, severity of the stroke and the delirium. One week after the patients used the drug, compare the mean dose of olanzapine, the treatment effect and the side effect of the two groups. We followed up all the 60 patients with modiifed Rankin Scale (mRS) after 3 months to evaluate the prognosis of the two methods of administration. Results ①There is no signiifcant difference between the oral group and the rectal group on the age, gender and the score of NIHSS and CAM: Media of NIHSS (8.5 vs 10;P=0.79)、CAM ([25.8±3.1] vs [26.1±5.3];P=0.79). Also the comorbidity of hypertension (6.7%vs 2.0%;P=0.18), diabetes (10.0%vs 23.3%;P=0.17) and coronary heart disease (CHD) (50.0%vs 60.0%;P=0.43) have no signiifcant differences between the two groups.②Both two groups' olanzapine orally and rectally are both well tolerated among these patients, and there is no signiifcant side effect on those 60 patients in the ifrst week ([5.33±2.12] vs [4.25±2.06];P=0.03).③The follow-up data after 3 months showed that there was no signiifcant difference between the two groups in the score of mRS (P=0.15). Conclusion Olanzapine administered rectally may be an effective and safe method for delirium patients, especially for those patients who are dififculty in taking oral medicine. And the dose of rectal use should be less than that of oral use.
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