重复经颅磁刺激联合脑波同步疗法对产后抑郁症疗效及激素水平的影响

目的 观察脑波同步、重复经颅磁刺激联合氟西汀与单纯氟西汀治疗产后抑郁的疗效差异。 方法 选取2013年6月-2015年6月杭州市第七人民医院48例产后抑郁症患者采用随机数字表法分成2组,联合组(25例)予以脑波同步、重复经颅磁刺激,联合药物氟西汀治疗;氟西汀组(23例)予以单纯药物治疗。采用汉密尔顿抑郁量表(HAMD)、爱丁堡产后抑郁量表(EPDS)、临床疗效总评量表(CGI)、不良反应量表(TESS)于治疗前及治疗第1、2、4、6周末进行评分,比较2组疗效与不良反应;于治疗前及治疗第6周末检测2组患者血清皮质醇(COR)、三碘甲状腺原氨酸(T3)、四碘甲状腺原氨酸(T4)、促甲状腺激素(TSH)、雌二醇水平变化。 结果 联合组于治疗第2、4、6周末HAMD、EPDS得分下降快于氟西汀组(P<0.01);联合组在治疗2周后CGI疗效指数(EI)高于氟西汀组(P<0.05),联合组在治疗6周后CGI疗效总评指标(GI)和疗效指数(EI)方面与氟西汀组相比差异有统计学意义(P<0.05);联合组于治疗4、6周后TESS评分均明显低于氟西汀组;联合组于治疗6周后血清TSH、COR、雌二醇水平较氟西汀组差异具有统计学意义(P<0.05)。 结论 脑波同步、重复经颅磁刺激联合氟西汀治疗产后抑郁具有起效快、药物用量少、不良反应少、患者依从性好等优点。 

Effect of brainwave synchronization therapy combined with repetitive transcranial magnetic stimulation on postpartum depression

Objective To explore the efficacy of combination therapy with brainwave synchronization,repetitive transcranial magnetic stimulation (r TMS) and fluoxetine in the treatment of postpartum depression. Methods Forty-eight cases of postpartum depression in Hangzhou Seventh People's Hospital between June,2013 and June,2015 were randomized into two groups.The combined treatment group (25 cases) received the combination therapy with brainwave synchronization,r TMS and fluoxetine,while the simple drug group (23 cases) only received fluoxetine treatment.The curative effect and adverse reactions were evaluated between the two groups by Hemilton depression scale (HAMD),Edinburgh postnatal depression scale (EPDS),clinical global impression (CGI) and treatment emergent symptom scale (TESS) before the treatment and 1,2,4 and 6 weeks after the treatment.The levels of serum cortisol (COR),three iodine thyroid glycine (T3),four iodine glycine (T4),thyroid-stimulating hormone (TSH) and estradiol were tested before the treatment and 6 weeks after the treatment. Results HAMD and EPDS score on the end of 2,4 and 6 weeks decreased obviously in the combined treatment group as compared with the fluoxetine group (P<0.01);CGI-EI on the end of 2 weeks in the combined treatment group was higher than that in the fluoxetine group (P<0.05);The difference in (CGI-GI and CGI-EI at 6 weeks after the treatment was statistically significant (P<0.05);TESS score on the end of 4 and 6 weeks in the combined treatment group was obviously lower than that in the fluoxetine group (P<0.01);After 6 weeks treatment,the difference in the levels of serum TSH,COR and estradiol was significant between the two groups (P<0.05). Conclusion The combination therapy with brainwave synchronization,r TMS and fluoxetine for postpartum depression is effective with less sideeffect.The small drug dosage can improve the compliance of patients.