摘要
背景:脑卒中后不仅导致躯体残疾,而且伴随心理损害时常发现抑郁、焦虑症状混合并存,无论焦虑症状是原发的还是继发的,在常规治疗原发病的同时均应同时应用药物治疗焦虑,抑郁症状。目的:探讨合并与不合并应用抗抑郁剂及应用不同抗抑郁剂对脑卒中后神经功能及焦虑、抑郁症状的疗效。设计:以患者为观察对象,随机对照、双盲实验。单位:兰州大学第二医院精神科和神经内科。对象:选择1999-07/2002-12兰州大学第二医院神经内科收治的脑卒中伴有焦虑、抑郁性精神障碍患者90例。随机分为帕罗西汀组、丙咪嗪组和对照组,每组30例,年龄41～72岁。方法:在急性期抢救治疗一两周后,意识清楚,生命体征平稳,无理解功能障碍,对照组常规治疗原发病及康复训练,帕罗西汀组在此基础上,同时服用帕罗西汀20mg/d,丙咪嗪组在此基础上,服用丙咪嗪50～150mg/d,共治疗12周,各组患者在治疗2,4,8,12周末进行神经功能缺损程度、生活自理程度、汉密顿抑郁量表(24项)、汉密顿焦虑量表(14项)评分。焦虑、抑郁症状疗效评估:按汉密顿焦虑、抑郁量表评分的减分率判断,减分率:痊愈>75%;50%≤显效<75%;25%≤进步<50%;无效<25%。神经功能疗效标准:基本痊愈:神经功能缺损程度评分减少90%～100%;显著进步:评分减少46%～89%;进步:评分减少18%～45%;无效:评分减少17%以下或病情恶化。主要观察指标:①各组患者治疗前后神经功能恢复情况。②各组患者治疗前后焦虑、抑郁恢复情况。③各组患者抑郁症状疗效及神经功能疗效。神经功能缺损程度、生活自理程度。④不良事件及副反应。结果:帕罗西汀组中途失访1例,对照组失访3例,丙咪嗪组由于副反应中途脱落3例,进入结果分析83例。①各组患者治疗前后神经功能恢复情况:治疗2,4周神经功能缺损程度、生活自理程度评分值变化较大(P<0.01),8,12周渐趋缓慢(P<0.05);治疗后帕罗西汀组神经功能缺损程度、生活自理程度评分与对照组比较差异有显著性意义(P<0.01),丙咪嗪组与对照组及帕罗西汀组与丙咪嗪组比较差异无显著性意义(P>0.05)。②各组患者治疗前后焦虑、抑郁恢复情况:治疗后2,4,8,12周帕罗西汀组与丙咪嗪组汉密顿抑郁量表、汉密顿焦虑量表评分明显低于对照组(P<0.01～0.001)。治疗12周后帕罗西汀组和丙咪嗪组比较差异无显著性意义(P>0.05)。③帕罗西汀与丙咪嗪对焦虑、抑郁症状有效率为86.6%及85.1%,明显优于对照组(46.6%),帕罗西汀、丙咪嗪和对照组神经功能恢复的有效率分别为89.6%,70.3%;56.6%,帕罗西汀组明显高于对照组(P<0.01),丙咪嗪组与对照组比较(P>0.05)。结论:对脑卒中后焦虑、抑郁及神经功能恢复需合并抗抑郁剂干预,帕罗西汀与丙咪嗪抗焦虑、抑郁疗效相同,前者副作用小,依从性好,对神经功能恢复效更佳。
BACKGROUND： In addition to physical disability, stroke may also result in psychological impairments usually manifested by depression and anxiety. Regardless of the primary or secondary onset of anxiety, anti-depressants should be given for treatment of the anxiety and depression besides routine treatment of the primary condition underlying the symptoms. OBJECTIVE： To compare the effect of different treatment protocols with or without anti-depressants and different anti-depressants on poststroke anxiety and depression as well as the neurological functions. DESIGN： Randomized controlled double-blind clinical trial. SETTING： Departments of Psychiatry and Neurology of the Second Hospital Affiliated to Lanzhou University. PARTICIPANTS： Ninety patients aged 41-72 years with post-stroke anxiety and depression, who were admitted in the Departments of Psychiatry and Neurology of the Second Hospital Affiliated to Lanzhou University between July 1999 and December 2002, were enrolled in this study and randomized equally into Paxil group, imipramine group and control group. METHODS： After emergency management for 1-2 weeks in the acute stage, the stroke patients showed clear consciousness and stable life signs without any understanding problems. Patients in the control group received conventional treatment combined with rehabilitative training, while patients in the other two groups were given additional Paxil （20 mg/day） or imipramifie （50-150 rag/day） for totally 12 weeks. The neurological deficits and capacity for independent living of the patients were assessed with Hamilton Depression Scale （24 items） and Hamilton Anxiety Scale （14 items） at 2, 4, 8, and 12 weeks during the treatment. A reduction of the score for Hamilton anxiety and depression scale by over 75% suggested a cure of depression and anxiety, 50% but 〈 75% obvious improvement, 25% but 〈 50% improvement, and 〈 25% non-response. Basically recovered neurological function was indicated by a reduction of neurological deficit score by 90%-100%, remarkable improvement by 46%-89%, improvement by 18%-45%, and non-response or exacerbation by a reduction less than 17%. MAIN OUTCOME MEASURS： ① Neurological function recovery of recovery of the patients after treatment;② Poststroke anxiety and depression status before and after treatment; ③ Therapeutic effects on depression, neurological functions, severity of neurological deficit, and capacity of independent living. ④Adverse events and side effects. RESULTS： One patient in Paxil group and 3 in the control group failed to be available for follow-up study, and 3 patients in imipramine group withdrew from the study due to adverse events, so that 83 cases were analyzed. At 2 and 4 weeks in the treatment, the scores for neurological deficits and capacity for independent living exhibited obvious changes （P 〈 0.01）, which gradually stabilized at 8 and 12 weeks （P 〈 0.05）, and significantly greater improvement in the neurological function and capacity for independent living was observed in Paxil group than in the control grouP （P 〈 0.01）, but the differences between imipramine group and the control group and between Paxil group and imipramine group were not statistically significant （P 〉 0.05）. The scores for Hamilton Depression Scale and Hamilton Anxiety Scale were obviously lower in Paxil group and imipramine group at 2, 4, 8 and 12 week than those in the control group （P 〈 0.01-0.001）, but similar between the former two groups at 12 weeks （P 〉 0.05）. Paxil and imipramine on resulted in curative rates of anxiety and depression of 86.6% and 85.1%, respectively, which were obviously higher than that of the control group （46.6%）; the improvement rate of.neurological function in Paxil group, imiprarnine group and control group was 89.6%, 70.3% and 56.6%, respectively, with that of Paxil group significantly higher than that of the control group （P 〈 0.01）, but the difference between imipramine group and control group Was not significant （P 〉 0.05）. CONCLUSION： Patients with poststroke anxiety and depression should receive appropriate interventions with anti-depressants in addition to treatment of neural function impairment. Paxil and imipramine have similar effect in treating anxiety and depression, but the former can be for its less side effects, better compliance on the part of patients and good effect in promoting neurological function recovery.
出处
《中国临床康复》
CSCD
北大核心
2006年第6期153-155,共3页
Chinese Journal of Clinical Rehabilitation
