高压氧联合艾司西酞普兰治疗脑卒中后抑郁症的临床疗效及其作用机制  

Clinical efficacy and mechanism of action of hyperbaric oxygen combined with escitalopram in the treatment of post-stroke depression

作　　者：刘海萍[1] 韩露[2] 杨丹 石少波[1] Liu Haiping;Han Lu;Yang Dan;Shi Shaobo(Psychiatry Department of Qingdao Mental Health Center,Qingdao 260034,China;Qingdao Municipal Hospital,Qingdao 266071,China;The Second People’s Hospital of Chengyang District,Qingdao,Qingdao 2660109,China)

机构地区：[1]青岛市精神卫生中心精神科,青岛260034 [2]青岛市市立医院,青岛266071 [3]青岛城阳区第二人民医院,青岛266109

出　　处：《中华航海医学与高气压医学杂志》2024年第3期305-309,共5页Chinese Journal of Nautical Medicine and Hyperbaric Medicine

摘　　要：目的:探讨高压氧(HBO)联合艾司西酞普兰治疗脑卒中后抑郁症的临床疗效及其作用机制。方法:选取2021年7月至2023年4月青岛市精神卫生中心和青岛市市立医院收治的脑卒中后抑郁症患者90例作为研究对象。采用随机数字表法将90例患者分为研究组和对照组,每组45例。对照组口服艾司西酞普兰,研究组在对照组的基础上予以HBO治疗。采用美国国立卫生研究院卒中量表(NIHSS)评估2组患者的神经功能及临床治疗效果;采用简易智能精神状态检查(MMSE)量表评价2组患者的认知功能;采用Barthel指数(BI)评分对患者的日常生活活动能力进行评估;采用蒙哥马利-艾森贝格抑郁评定量表(MADRS)对患者的抑郁状况进行评分。分别于治疗前后抽取清晨空腹静脉血,采用酶联免疫吸附法测定患者血清白细胞介素(IL)-1、IL-6、IL-8、高敏C反应蛋白(hsCRP)水平及睫状神经营养因子(CNTF)、脑源性神经营养因子(BDNF)水平。结果:研究组患者治疗后治疗总有效率(91.11%)明显高于对照组(71.11%),差异有统计学意义( χ^(2)=5.874, P<0.05)。研究组治疗后NIHSS、MADRS评分明显低于对照组,MMSE、BI评分明显高于对照组(均 P<0.001)。与治疗前比较,2组患者治疗后血清IL-1、IL-6、IL-8、hsCRP水平均明显降低,且研究组治疗后均明显低于对照组(均 P<0.001)。与治疗前比较,2组患者治疗后血清CNTF、BDNF水平均明显升高,且研究组治疗后均明显高于对照组(均 P<0.05)。 结论:HBO联合艾司西酞普兰治疗脑卒中后抑郁症患者临床疗效较好,其主要作用机制可能与改善脑组织氧供、降低炎症反应、促进神经功能的修复有关。ObjectiveTo study the clinical efficacy and mechanism of action of hyperbaric oxygen combined with escitalopram in the treatment of post-stroke depression.MethodsA total of 90 patients with post-stroke depression admitted to Qingdao Mental Health Center and Qingdao Municipal Hospital from July 2021 to April 2023 were selected as the subject.They were divided into observation group and control group according to the random number table method,with 45 cases in each group.The control group took escitalopram orally,and the observation group was additionally given hyperbaric oxygen therapy on the basis of the treatment of the control group.The neurological function and clinical efficacy of two groups were evaluated by the National Institutes of Health stroke scale(NIHSS);the cognitive function of two groups was evaluated by the mini-mental state examination(MMSE)Scale;patients’ability to perform daily activities of life was evaluated by Barthel index(BI)score;the depression status of patients was scored by the Montgomery-Asberg depression rating scale(MADRS).Before and after treatment,fasting venous blood was collected in the morning,and the levels of serum interleukin(IL)-1,IL-6,IL-8,high-sensitivity C-reactive protein(hsCRP),ciliary neurotrophic factor(CNTF),and brain-derived neurotrophic factor(BDNF)were measured using enzyme-linked immunosorbent assay.ResultsThe total effective rate of the observation group(91.11%)was higher than that of the control group(71.11%),with a statistically significant difference(χ^(2)=5.874,P<0.05).After treatment,the NIHSS and MADRS scores of the observation group were significantly lower than those of the control group,while the MMSE and BI scores were significantly higher than those of the control group(all P<0.001).Compared with those before treatment,the serum levels of IL-1,IL-6,IL-8,and hsCRP in both groups were significantly reduced after treatment,and the levels of the observation group were significantly lower than those of the control group after treatment(all P<0.001).Com

关 键 词：抑郁症 脑卒中 高压氧 艾司西酞普兰 

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]