经颅磁刺激联合氟西汀治疗卒中后抑郁的临床效果  

Clinical effect of repetitive transcranial magnetic stimulation combined with Fluoxetine in the treatment of post-stroke depression

作　　者：孙蓉[1] 杜晓霞[1] 肖琳[1] 宋明洁 何静杰[1] SUN Rong;DU Xiaoxia;XIAO Lin;SONG Mingjie;HE Jingjie(Department of Neurorehabilitation,China Rehabilitation Research Center,Beijing Boai Hospital,Beijing 100068,China)

机构地区：[1]中国康复研究中心北京博爱医院神经康复科,北京100068

出　　处：《中国医药导报》2022年第17期76-79,共4页China Medical Herald

基　　金：国家重点研发计划主动健康和老龄化科技应对重点专项(2020YFC2004100);国家重点基础研究发展计划(973计划)(2013CB837300)。

摘　　要：目的 观察不同模式重复经颅磁刺激(rTMS)联合氟西汀治疗卒中后抑郁(PSD)的临床效果。方法 选取中国康复研究中心北京博爱医院2020年1月至2021年11月收治的PSD患者60例,按照随机数字表法分为低频治疗组、高频治疗组和对照组,每组各20例。分别给予1、5 Hz的rTMS及假刺激14 d,三组同时予以氟西汀20 mg/d、常规药物治疗及康复治疗28 d。于治疗前、治疗第7、14、28天,比较三组汉密尔顿抑郁量表(HAMD)、美国国立卫生研究院卒中量表(NHISS)、改良Barthel指数(MBI)、简易精神状态检查量表(MMSE)评分变化及不良反应。结果 整体分析显示,三组HAMD评分时间、组间、交互作用比较,差异有统计学意义(P <0.05)。进一步两两比较,组内比较:低、高频治疗组治疗第7、14、28天HAMD评分低于同组治疗前,对照组治疗第14、28天HAMD评分低于同组治疗前,差异有统计学意义(P <0.05)。组间比较:治疗前,各组HAMD评分比较,差异无统计学意义(P> 0.05)。治疗后,低、高频治疗组HAMD评分低于对照组,差异有统计学意义(P <0.05)。治疗第28天,三组NHISS评分低于治疗前,MBI、MMSE评分高于治疗前,差异有统计学意义(P <0.05)。治疗第28天,三组NHISS、MBI评分比较,差异有统计学意义(P <0.05)。其中,低、高频治疗组NHISS评分低于对照组,MBI评分高于对照组,差异有统计学意义(P <0.05)。对照组和低频治疗组在治疗过程中未出现不良反应,高频治疗组有3例患者治疗后出现轻中度短暂性头痛,休息后自行缓解。结论 rTMS联合氟西汀治疗和氟西汀单独治疗均能改善PSD患者的情绪、减轻神经功能缺损,提高日常生活活动能力和认知水平;联合治疗起效更快,疗效更显著,且磁刺激停止后疗效仍可持续,不良反应小。Objective To observe the clinical effect of different modes of repetitive transcranial magnetic stimulation(rTMS) combined with Fluoxetine in the treatment of post-stroke depression(PSD). Methods A total of 60 PSD patients admitted to Beijing Boai Hospital of China Rehabilitation Research Center from January 2020 to November 2021 were selected and divided into low frequency treatment group, high frequency treatment group, and control group according to the random number table method, with 20 cases in each group. rTMS at 1, 5 Hz, and sham stimulation were given for14 days, respectively. The three groups were also given Fluoxetine 20 mg/d, conventional drug therapy and rehabilitation therapy for 28 days. Before treatment, on the 7th, 14th, and 28th days of treatment, the scores of Hamilton depression scale(HAMD), National Institute of Health stroke scale(NHISS), modified Barthel index(MBI), and mini-mental state examination(MMSE) and adverse reactions were compared among the three groups. Results The overall analysis showed that there were significant differences in HAMD score time, between groups, and interaction among the three groups(P < 0.05). Further pairwise comparison and intra-group comparison: the HAMD scores of the low and high frequency treatment groups on the 7th, 14th, and 28th days of treatment were lower than those before treatment in the same group, while the HAMD scores of the control group on the 14th and 28th days of treatment were lower than those before treatment in the same group, and the differences were statistically significant(P < 0.05). Comparison between groups: before treatment, there was no significant difference in HAMD scores between groups(P > 0.05). After treatment, the HAMD scores in the low and high frequency treatment groups were lower than those in the control group, and the differences were statistically significant(P < 0.05). On the 28th day of treatment, the NHISS scores of the three groups were lower than those before treatment, while the scores of MBI and MMSE were higher

关 键 词：经颅磁刺激 卒中 抑郁 氟西汀 

分 类 号：R749.1[医药卫生—神经病学与精神病学]