米氮平与阿米替林对脑卒中后抑郁患者疗效与认知功能的影响  

Influences of mirtazapine and amitriptyline on curative effect and cognitive function of patient with post-stroke depression

作　　者：吕应春[1] 王振英[1] 宋景贵[1] 王长虹[1] 

机构地区：[1]河南省精神病医院,新乡453002

出　　处：《中国实用神经疾病杂志》2012年第10期12-15,共4页Chinese Journal of Practical Nervous Diseases

基　　金：2011河南省科技发展项目(编号112102310211)

摘　　要：目的探讨米氮平与阿米替林治疗脑卒中后抑郁的临床疗效及对患者认知功能的影响。方法将64例脑卒中后抑郁患者随机分为研究组(米氮平组)32例,对照组(阿米替林组)32例。于治疗前和治疗第1周、2周、4周、6周末采用汉密顿抑郁量表和P300电位进行抑郁状态和认知功能测定。结果治疗前2组HAMD评分差异无统计学意义,治疗各时段2组评分均较治疗前显著下降(P<0.05或0.01),治疗1周末和2周末研究组评分较对照组下降更显著(P<0.05),研究组总分减分率较对照组升高更显著(P<0.05);治疗1周末2组P300电位测定差异均有统计学意义(P<0.05),但治疗6周末研究组P300电位N2、P3波潜伏期缩短和P3波幅升高较对照组显著(P<0.05);治疗6周末2组服药依从性均较治疗前显著提高(P<0.01),研究组较对照组提高更显著(P<0.01);治疗后研究组不良反应发生率21.9%,对照组为46.9%,差异有统计学意义(χ2=4.43,P<0.05)。结论米氮平治疗脑卒中后抑郁疗效与阿米替林相当,但米氮平起效明显快于阿米替林,且对改善卒中后抑郁患者的认知功能、提高治疗的依从性明显优于阿米替林。Objective To explore the influences of mirtazapine and amitriptyline on curative effect and cognitive function of patient with post stroke depression （PSD）. Methods Sixty-four PSD patients were randomly divided into two groups of 32 ca- ses each, research group was treated with mirtazapine and control group with amitriptyline. Depression slates were assessedwith the Hamilton depression rating scale（HAMD） and cognitive function assayed with P300 potential before treatment and at theend of the 1st, 2nd, 4th and 6th week of treatment. Results There was no significant difference in the HAMD score between two groups before treatment. Compared to that pretreatment, the HAMD scores of each periods of both groups lowered more significantly （P〈0.05 or 0.01）, those did more significantly in the research than control group at the end of the 1st and 2nd week （P〈0.05）, and the score-reducing rate of total score heightened more significantly in the research than control group （P 〈0.05） ; at the end of the 1st week, there were no significant differences in P300 potential （P〈0.05）, but at the end of the 6th week, N2 and P3 latency shortened and P3 amplitude heightened more significantly in the research than control group （P〈 0.05） ; at the end of the 6th week, drug compliance of both groups heightened more significantly compared to pretreatment（P 〈0.01）, which did more significantly in the research than control group（P〈0.01） ; the incidence of adverse reactions was re- spectively 21.9% in the research and 46.9% in the control group, the difference was significant （X2= 4.43, P〈0.05）. Conclusion Mirtazapine has an efficacy equivalent to amitriptyline in the treatment of post-stroke depression, but the former takes effect more rapidly and has notable advantages in improving cognitive function and treatment compliance.

关 键 词：米氮平 阿米替林 脑卒中后抑郁 认知功能 依从性 P300电位 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R749.4[医药卫生—临床医学]