重复经颅磁刺激对脑卒中后抑郁患者抑郁情绪及认知功能的影响  

Effects of repetitive transcranial magnetic stimulation on depression and cognition in the treatment of post- stroke depression

作　　者：张朝辉[1] 穆俊林[2] 耿彩虹[1] 李强[1] 宋景贵[3] 

机构地区：[1]新乡医学院第二附属医院心身二科,新乡453002 [2]新乡医学院第二附属医院电生理研究室,新乡453002 [3]新乡医学院第二附属医院神经内科,新乡453002

出　　处：《中华物理医学与康复杂志》2013年第3期197-200,共4页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：河南省教育厅自然科学研究计划项目（2009A320014）;河南省医学科技攻关项目（201203071）

摘　　要：目的探讨重复经颅磁刺激（rTMS）联用氟西汀治疗对脑卒中后抑郁（PSD）患者抑郁情绪及认知功能的影响。方法采用随机数字表法将82例PSD患者分为治疗组及对照组，同时选取40例健康对象纳入正常组。2组患者均给予神经内科常规干预，治疗组同时辅以rTMS及氟西汀联合治疗，对照组仅给予氟西汀治疗。于治疗前、治疗8周后采用汉密尔顿抑郁量表（HAMD）评定患者抑郁程度改善情况，采用事件相关电位P300及探究性眼动分析（EEM）评价患者认知功能改变。结果经8周治疗后，发现治疗组HAMD评分[（9．47±3．47）分]及对照组HAMD评分[（12．80±3．45）分]均较治疗前明显下降（P〈0．05），并且以治疗组HAMD评分的下降幅度较显著，与对照组间差异具有统计学意义（P〈0．05）。人选时治疗组及对照组N2波潜伏期[分别为（278．8±16．0）ms和（279．0±16．4）ms]、P3波潜伏期[分别为（377．1±17．5）ms和（378．0±16．8）ms]均较正常组延长，治疗组及对照组P3波幅[分别为（3．60±1．76）μV和（3．68±1．59）μV]均较正常组明显降低；EEM检查结果亦显示治疗组及对照组凝视点[分别为（16．98±5．32）个和（17．46±5．32）个]及反应性探索评分[分别为（4．29±1．55）分和（4．41±1．56）分]均较正常组明显降低。经治疗8周后，发现治疗组及对照组N2波潜伏期[分别为（244．5±15．9）ms和（261．7±13．3）ms]、P3波潜伏期[分别为（343．5±17．1）ms和（361．0±14．9）ms]均较治疗前缩短，P3波幅[分别为（6．38±1．89）μV和（5．50±1．83）μV]均较治疗前增大；2组患者凝视点[分别为（23．61±3．87）个和（20．68±4．54）个]及反应性探索评分[分别为（6．61±1．70）分和（5．44±1．57）分]亦较治疗前明显改善；并且上述指标均以治疗组的改善幅度较显著，与对照组间差异均具有统计学意�Objective To explore the effects of repetitive transcranial magnetic stimulation （rTMS） and fluoxetine on depression and cognition in the treatment of post-stroke depression （PSD）. Methods A total of 82 PSD patients were divided into a treatment group and a control group using a random number table. Besides conventional neurological therapy, the treatment group was treated with rTMS combined with fluoxetine, while the control group was treated only with fluoxetine. Forty healthy persons acted as normal controls. The Hamilton depression rating scale （HAMD） was used to evaluate depressed emotions, and event-related potential （ERP） P300 and exploratory eye movement （EEM） were used to evaluate cognitive function. The three groups were tested before treatment and after 8 weeks of treatment. Results After 8 weeks of treatment the HAMD scores in both the treatment and control groups had decreased significantly compared with before treatment. The HAMD scores decreased significantly more in the treatment group than in the control group. Before treatment, the N2 and P3 latencies of P300 in the treatment and control groups were significant longer than those in the normal group, and the average amplitude of P3 in the treatment and control groups was significantly lower than among the normal controls. Before treatment, the number of eye fixations （NEF） and the average responsive search score （RSS） in the treatment group and control groups were significantly lower than in the normal group. After 8 weeks after treatment, the N2 and P3 latencies were significantly shorter and the amplitude of P3 was significantly higher in the treatment and control groups than before treatment. The NEF and the average RSS in the treatment and control groups had increased significantly compared with before treatment. All of these indexes improved significantly more in the treatment group than in the control group. Conclusion rTMS combined with fluoxetine can improve depression and cognitive function among PSD patients

关 键 词：卒中后抑郁 重复经颅磁刺激 氟西汀 认知功能 

分 类 号：R74[医药卫生—神经病学与精神病学]