不同时段脑卒中后抑郁的药物干预治疗对比研究

目的使用HAMD、MoCA、SAS和NIHSS四项量表综合评价脑卒中后72 h、1和2月发生脑卒中后抑郁(post-stroke depression,PSD)患者的抗抑郁药物干预效果,为不同时段的PSD药物干预提供临床研究依据。方法入选脑卒中病例223例,于脑卒中后72 h予HAMD评分,≥8分者随机分为72 h对照组和72 h治疗组;余患者于脑卒中后1月再次予HAMD评分,评分≥8分者随机分为1月对照组、1月治疗组;余患者于脑卒中后2月再次予HAMD评分,评分≥8分者同前再随机分为2月对照组、2月治疗组;各组均予常规药物及相同的康复治疗方案,治疗组加用帕罗西汀20 mg/d治疗。对以上各组病例于脑卒中后3个月随访,进行HAMD(24项版)量表、SAS量表、MoCA量表及NIHSS量表的评分。结果 (1)72 h治疗组与对照组比较,HAMD评分无显著差异(P>0.05),而MoCa、SAS和NIHSS评分均有显著差异(P≤0.01);1月治疗组与对照组比较,SAS评分无显著差异(P>0.05),而HAMD、SAS和NIHSS评分均有显著差异(P<0.01),2月治疗组与对照组的四项量表评分比较均有显著差异(P<0.01);(2)72 h、1月和2月治疗组在第3个月随访时的MoCa、SAS、HAMD及NIHSS评分均无显著差异(P>0.05)。结论 (1)脑卒中后不同时间出现PSD患者的抗抑郁干预效果有时间段差异,PSD出现时间越晚,抗抑郁治疗达到明显效果所需的时间越短;(2)脑卒中患者发生PSD后及早予抗抑郁药物治疗,不仅可改善抑郁,对焦虑、认知和神经功能康复也有积极效果。

The comparison research of anti-depression medicine treatment to post-stroke depression patients occurred in different time

To study the effect of anti-depression medicine for poststroke depression （PSD） patients respectively 72 hours, 1 month and 2 month after stroke by HAMD, MoCA, SAS and NIHSS scale. And to surpply the clinical research evidence for treatment of PSD occurred in different time. Methods 223 stroke patients were enrolled in the research. They were all scored with HAMI） scale 72h after stroke and those whose HAMD scale 8 were divided randomly into 72h control group and 72h treatment group. The rest patients were scored again with HAMD scale 1M after stroke and those whose HAMD scale ~8 were di- vided randomly into 1M control group and 1M treatment group. And the rest patients were scored with HAMD scale 2M after stroke and those whose HAMD scale ~8 were divided randomly into 2M control group and 2M treatment group. All patients were given the same rutine medicine and recovery schedule. Paroxetine hydrochloride （20rag/d） was applied in the treatment group. All patients were followed up in 3 months after stroke and scored with HAMD, SAS, MoCA and NIHSS scale. Results （1）There were remarkably difference between 72h control group and 72h treatment group of SAS, MoCA and NIHSS scale （P〈0. 01）and no statistical difference of HAMD scale（P〈0.05）. There were statistical difference between 1M control and 1M treatment group of HAMD, MoCA and NIHSS scale （P%0. 01） and no statistical difference of SAS scale （P〈0. 05）. The HAMD, MoCA, SAS and NIHSS scale were all obviously different between 2M control and treatment group （P〈0. 01 ）. Conclusions （1） There are period different of antidepression medicine treatment in PSI） patients occurred in different time after stroke. The later the PSI） occure, the shorter the antidepression treatment arrives excellent effect. （2） Antidepression treatment should give as early as possible to PSI） patients after stroke. It not only could improve the depression degree, also has positive effect on anxiety, cognition and recovery of neurological functions.