脑卒中后抑郁状态不同疗法效果的对照研究(1)
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【摘要】 目的 对比不同疗法治疗卒中后抑郁状态的疗效。方法 将215例卒中后抑郁状态患者随机分为电针组、氟西汀组、康复组、电针+康复组、电针+氟西汀组、康复+氟西汀组以及康复+电针+氟西汀组。电针组采用智能电针仪治疗,用抑郁波型,以毫针针刺百会、印堂穴,强度2-3V,45 min/次,1次/d,每周5次。同时服用安慰剂;氟西汀组给于氟西汀胶囊20 mg/d,并接受模拟电针;康复治疗组:主要采用神经促通技术治疗,疗程6周。与治疗前及治疗中每2周评定汉密尔顿抑郁量表(HAMD)、抑郁自评量表(SDS)。结果 治疗第6周末,七组中,每组治疗后与治疗前相比,P<0.05,差异具有统计学意义。治疗后单组中电针组、氟西汀组及康复组之间差异不显著。而联合四组中,与单组比较,P<0.05,差异具有显著性。其中康复+电针+氟西汀组HADM评分明显低于其他六组,差异均具有显著性。各组中HAMD评分均随治疗时间的延长而逐步下降,提示各组治疗手段均有明显的抗抑郁作用。结论 单一各组治疗卒中后抑郁症的疗效基本相同,而联合组优于单一组,其中以康复训练+电针+氟西汀组改善最为显著。
【关键词】 电针;氟西汀;抑郁症;康复
【Abstract】 Objective To compare the therapeutic effectiveness using different treatment methods for the post-stroke depression condition. Methods 125 patients with the post-stroke depression condition were randomly divided into 7 groups: electroacupuncture group, fluoxetine group, rehabilitation group, :electroacupuncture plus rehabilitation group, electroacupuncture plus fluoxetine group, the rehabilitation group plus fluoxetine group, and electroacupuncture plus rehabilitation and fluoxetine group. The patients in the electroacupuncture group were treated both by the placebo and the intelligent electric acupuncture apparatus, the acupuncture needles being on the Bai-Hai and Yin-Tang acupuncture point using the depression waveform with intensity 2-3v,45 min per day and 5 times per week.The fluoxetine group was given the fluoxetine capsules 20 mg per day with shamelectroacupuncture treatment.The rehabilitation group was treated 6 weeks by the neural ameliorative technique .The Hamiltion Depression Rating Scale (HDMD) and self-rating depression scale (SDS) were evaluated before and two weers after treatment. Result Six weeks after therapy,differences between the pre-and post-treatment scales were statically significant in all seven groups (P<0.05).Reslts of each groups with single treatment method had no significant differences,,but the comparison between the multiple treatment groups and the singletreatment groups showeddifferences (P<0.05). The electroacupuncture plus rehabilitation and fluoxetine group had the lowest HADM scale than any other six groups with significant differences. The fact that the HADM scales graduslly decreased whith time in each group indicatrd the apparent anti-depression dffect of all treatment methods.Conclusion Any single treatment method for the post-stroke depression condition and similar efficiency.Outcome of the patients treated by the multiple treatment methods was better than those treated by the single method.In addition,the treatment method of electroacupuncture plus rehabilitation and fluoxetine showed most significant efficiency.
【Key words】 Electroacupuncture; Fluoxetine; Post-stroke depression; Rehabilitation
抑郁症是一种患病率搞、严重危害人类心身健康、具有高自杀的精神疾病;很多文献报道,电针、康复、氟西汀药物治疗抑郁症效果满意;为进一步验证疗效,在以往工作的基础上,笔者对各组的疗效进行了对照研究。
1 资料与方法
1.1 一般资料
1.1.1 纳入标准 收集本院2005年7月至2008年9月神经内科住院的脑卒中后合并抑郁症患者221例,平均年龄(62±10)岁。入院标准:①全部病例均经CT或者MRI诊断证实,符合第四届全国脑血管疾病会议制定的诊断标准;②查体:意识清楚;③检查合作无明显智能减退和失语;④无阳性精神障碍个人史和家族史。患者有自知力并签署知情同意书。
1.1.2 排除标准 首诊1周内未服用抗抑郁制剂。2周内无使用单胺氧化酶抑制剂,治疗中不合并使用其他抗抑郁药合抗精神病药物。近3个月内无使用过甘草、皮质激素或类似物。无精神疾病史和癫痫病史。排除老年良性记忆减退、老年痴呆和神经衰弱。
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