米氮平治疗急性卒中后抑郁的疗效及其对康复的作用  

The efficacy of mirtazapine for acute poststroke depression and its effect on post stroke rehabilitation

作　　者：张桂云[1] 潘玉红[1] 

机构地区：[1]山东省菏泽市立医院分院神经内科,274000

出　　处：《中国脑血管病杂志》2007年第4期164-167,共4页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的观察米氮平治疗急性卒中后抑郁的疗效及其对卒中康复的影响。方法109例急性卒中后抑郁患者随机分为米氮平组(55例)和对照组(54例),两组患者均接受常规药物治疗,米氮平组同时加用米氮平治疗。治疗前后应用Hamilton抑郁量表(HRSD)评价抑郁状况,治疗前、治疗后4周末和12周末,采用简易智能状态量表(MMSE)、中国卒中量表(CSS)和Barthel指数(BI)评价患者的认知和神经功能状况。结果治疗后12周末,米氮平组患者痊愈35例(64%),总有效52例(95%);对照组患者痊愈9例(17%),总有效31例(57%),两组比较差异有统计学意义(χ2=6.75、5.52,P<0.05)。治疗后4周末和12周末时,米氮平组MMSE评分较对照组显著增加(t=2.93、3.12,P<0.01);治疗后4周末,两组CSS和BI评分均有改善,但差异无统计学意义;治疗后12周末,米氮平组CSS和BI评分均优于对照组(t=5.02、10.25,P<0.01)。米氮平的主要不良反应为中枢神经系统和消化系统反应,但症状轻微。结论米氮平治疗卒中后抑郁安全有效,且能改善12周末时的认知功能和神经功能。Objective To observe the efficacy of mirtazapine in the treatment of poststroke depression （PSD） and its effect on post stroke rehabilitation. Methods A total of 109 patients with PSD were randomly allocated into a mirtazapine-treated group （ n = 55 ） and a control group （ n = 54）. Both groups were treated with conventional drugs, and mirtazapine was added to the treated group. The depression status of the patients was evaluated with the Hamilton Rating Scale for Depression （HRSD） before and after the treatment, their cognitive and neurological status were evaluated with the Mini-Mental State Examination （MMSE）, Chinese Stroke Scale （CSS） and Barthel Index （BI） 4 and 12 weeks before and after the treatment. Results Twelve weeks after the treatment, 35 patients （64%） were cured, and totally 53 patients （95%） were effective in the mirtazapine-treated group; 9 patients （17%） were cured and totally 31 patients （57%） were effective in the control group, the differences were statistically significant between the two groups （X2 = 6. 75, 5.52, P 〈 0. 05）. The MMSE score increased significantly in the mirtazapinetreated group than that in the control group 4 and 12 weeks after treatment （t = 2.93, 3.12, P 〈0. 01 ）. Both CSS and BI improved in the 2 groups 4 weeks after the treatment, but there was no statistically significant difference between the two groups. CSS and BI scores in the mirtazapine-treated group were better than those in the control group 12 weeks after the treatment （t =5.02, 10. 25, P 〈0. 01 ）. The major adverse effects of mirtazapine were appeared in digestive and central nervous system symptoms ; however, they were mild and transient. Conclusion Mirtazapine is safe and effective in the treatment of PSD, and it may improve cognitive function, neurological function, and the final outcome of the patients.

关 键 词：抗抑郁药 抑郁 脑血管意外 康复 

分 类 号：R749.1[医药卫生—神经病学与精神病学]