认知行为疗法联合抗抑郁药改善产后抑郁症状的效果研究  

Effectiveness of cognitive behavioral therapy combined with antidepressant on postpartum depression

作　　者：李丽君[1] 胡卫疆[1] 高雅坤[1] 黄晶[1] 张宁[1] 陈琦[1] 王春雪[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经精神与临床心理科国家神经系统疾病临床医学研究中心北京脑重大疾病研究院脑卒中研究所脑血管病转化医学北京重点实验室,北京100050

出　　处：《中国计划生育和妇产科》2017年第8期23-26,F0003,共5页Chinese Journal of Family Planning & Gynecotokology

基　　金：北京市科学技术委员会资助项目(项目编号:Z151100003915117;Z151100004015127;Z161100000216131)

摘　　要：目的系统评价认知行为疗法(cognitive behavioral therapy,CBT)联合抗抑郁药改善产后抑郁症(postpartum depression,PPD)患者抑郁症状的疗效。方法计算机检索Pubmed、Cochrane Library、OVID、中国知网(CNKI)、中国生物医学文献数据库(CBM)、中文科技期刊数据库(VIP)、万方数据库(Wanfang Data)中所有关于CBT联合抗抑郁药治疗PPD患者的随机对照试验,对符合纳入标准的文献用Rev Man 5.3软件对文献数据进行meta分析,对比两组的疗效。结果共纳入12个研究,共计849人。本文对CBT联合抗抑郁药治疗8周的疗效进行了分析,第1周、第2周、第4周、第6周及第8周的结果分别为[WMD=-1.31,95%CI(-2.53,-0.10),P=0.03]、[WMD=-2.87,95%CI(-3.46,-2.28),P<0.00001]、[WMD=-3.40,95%CI(-3.98,-2.82),P<0.00001]、[WMD=-2.66,95%CI(-3.67,-1.65),P<0.00001]及[WMD=-3.60,95%CI(-3.95,-3.25),P<0.00001]。CBT联合药物治疗组疗效优于单纯药物治疗组。结论CBT联合抗抑郁药较单纯使用抗抑郁药能更显著地改善PPD患者的抑郁症状,其疗效在治疗第1周开始便优于同期单纯药物治疗组。Objective To evaluate the efficacy of cognitive behavioral therapy（CBT） combined with antidepressants in patients with postpartum depression （PPD）. Methods Scientific databases including PubMed, Cochrane Library, OVID, China National Knowledge Infrastructure（ CNKI）, Chinese Biomedical Literature Database （CBM）, Chinese science and technology data （VIP） and Wanfang Data were searched. Only randomized controlled studies were included. Selected studies data were analyzed using RevMan 5. 3 and random effects model. Comparisons were conducted to confirm whether there were significant differences in two groups. Results Twenty studies including 849 subjects were analyzed. The results of CBT combined with antidepressant therapy for 8 weeks were analyzed. The results of week 1, week 2, week 4, week 6 and week 8 were[ WMD = - 1.31,95% CI（ - 2. 53, - 0. 10） ,P = 0. 03 ] , [WMD= -2.87,95%CI（ -3.46,-2.28）,P〈0.0000],[WMD= -3.40,95%CI（ -3.98, -2.82）,P〈0.00001],[WMD= - 2. 66,95 % CI（ - 3.67, - 1.65 ）, P 〈 0. 00001 ], [ WMD = - 3.60,95% CI （ - 3.95, - 3.25 ）, P 〈 0. 00001 ]. The results showed that the efficacy of CBT intervention group were significantly better than that of the control group. Conclusion CBT combines with antidepressant can significantly improve depressive symptoms of PPD patients. Its efficacy in the first week of treatment is better than the same period of simple drug treatment group.

关 键 词：产后抑郁 认知行为疗法 抗抑郁药 meta分析 

分 类 号：R714.7[医药卫生—妇产科学]