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目的 探讨奥氮平联合丙戊酸钠与奥氮平单药治疗创伤性脑损伤后冲动攻击行为的效果,为脑外伤所致攻击行为的治疗提供有效防范.方法 采用回顾性分析方法,总结急救中心创伤性脑损伤后出现冲动攻击行为的患者的一般资料、受伤原因、损伤脑区等临床资料,对比奥氮平联合丙戊酸钠治疗组与奥氮平单药治疗组两组患者在治疗前后修改版外显攻击行为量表的得分情况及治疗药物副作用情况.结果 共入组68人,男性46名,女性22名,平均年龄(33.87±6.15)岁,随机分为联合治疗组36人和对照组32人,两组在药物治疗第1周、第2周、第3周和第4周后的修订版外显攻击行为量表得分分别为12.17±4.83、9.11±4.18、7.14±3.29、3.69±3.46以及12.94±4.13、10.56±3.71、9.00±3.30、5.12±3.21,两组在治疗2周后得分差异有显著性意义(P＜0.05),联治疗组有效率88.9%,观察组为84.4%,差异没有显著性意义(P＞0.05),两治疗组副反应发生情况无明显差异.结论 在创伤性脑损伤后冲动攻击行为方面,奥氮平联合丙戊酸钠与奥氮平单药治疗两种方案均可使患者的冲动攻击行为得到明显的改善,其中联合治疗组患者起效更快,症状改善更为明显.“,”Objective To compare the effects of olanzapine and olanzapine combined with sodium valproate on impul?sive and aggressive behaviors caused by traumatic brain injury(TBI). Methods 68 patients of TBI, 48.5% in temporal lobe, 38.2% in frontal lobe, and 13.2% in multiple lobes, all with impulsive aggressive behavior, 46 males and 22 fe?males, aged(33.87±6.15), were randomly divided into 2 groups: control group(n=32)receiving only olanzapine at the maximum dose of 10~20 mg/day for I month, and combined treatment group(n = 36)receiving olanzapine com?bined with sodium valproate treatment with sodium valproate at the maximum dose of 1000 mg/day in addition to olan?zapine as described above for I month. The Modified Overt Aggression Scales(MOAS)was used to evaluate the severi?ty of the impulsive aggressive behaviors once a week since I week after the treatment. The rate of side effects was ob?served too. Results There was no significantly difference in the MOAS scores between these 2 groups before treatment (P>0.05). The MOAS scores of the two groups decreased gradually after the treatment, and scores of the combined treatment group since the 2nd week after treatment were significantly lower than those of the observation group(all P<0.05). There were no significant difference in efficiency rates between these two groups(88.9% vs. 84.4%, P＞0.05). Conclusion The curative effects of pure olanzapine and olanzapine combined with sodium valproate are equal. Howev?er the treatment of olanzapine combined with sodium valproate shows a faster effect and improves the symptoms more obviously.