老年抑郁精神障碍的临床研究

目的观察综合医院老年躯体疾病住院患者伴抑郁障碍的临床特征和探讨文拉法辛与氟西汀治疗抑郁障碍的疗效及安全性。方法采用抑郁自评量表（SDS）评定抑郁障碍伴抑郁障碍患者99例,随机分为3组,分别用抗抑郁药文拉法辛联合心理支持治疗（文拉法辛组,38例）,氟西汀联合心理支持治疗（氟西汀组,24例）和心理支持治疗（对照组,37例）,疗程8周。于治疗前和治疗2、4、6、8周末采用汉密顿抑郁量表评定临床疗效,并进行分析。结果文拉法辛组和氟西汀组治疗后SDS评分为（44.72±8.67）分低于治疗前的（56.98±6.92）分,差异有统计学意义（P〈0.05）;治疗后各组与治疗前相比HAMD评分持续显著下降（P均〈0.01）。文拉法辛组HAMD评分在治疗各周均显著低于对照组（P〈0.01或P〈0.05）,治疗4周后显著低于氟西汀组（P〈0.01或P〈0.05）。治疗4周后氟西汀组HAMD评分显著低于对照组（P〈0.05）。文拉法辛组治疗后CGI-SI评分为（1.55±0.68）分低于治疗前的（3.87±0.85）分,差异有统计学意义（P〈0.01）;氟西汀组治疗后CGI-SI评分为（1.56±0.72）分低于治疗前的（3.94±0.84）分,差异有统计学意义（P〈0.05）。结论老年人躯体疾病伴抑郁障碍发生率高,抗抑郁药物联合心理支持治疗较单纯心理支持疗效显著。文拉法辛治疗抑郁障碍起效快、疗效更佳,安全性高,依从性好。

The clinical study on depressive disorder of senile inpatients

Objective To observe clinical features of depressive disorder of senile inpatients with somatopathy in general hospital and discuss the effects and safety of venlafaxine and fluoxetine in depression.Methods All patients were randomly divided into three groups,venlafaxine group（38 cases）,fluoxetine group（24 cases）and control group（37 cases）,treatment for 8 weeks.The treatment effects were assessed with the HAMD and adverse reactions with the SDS before treatment and at the ends of the 2nd,4th,6th and 8th week treatment.Results The SDS score of venlafaxine group and fluoxetine group（44.72±8.67）] was lower than that（56.98±6.92）] before treatment,there was a statistical significance（P0.05）.Compared with before treatment,HAMD score of 3 groups continued to decline significantly（P0.01）.HAMD score of venlafaxine group at every weeks were lower than that in control group（P0.01 or P0.05）,after 4 weeks lower than fluoxetine group（P0.01 or P0.05）.After 4 weeks,HAMD score of fluoxetine group was lower than control group（P0.05）.After treatment,CGI-SI score of venlafaxine group（1.55±0.68）] was lower than that before treatment（3.87±0.85）],there was a statistical significance（P0.01）;CGI-SI score of fluoxetine group（1.56±0.72）] was lower than that before treatment（3.94±0.84）],there was a statistical significance（P0.05）.Conclusion Drug therapy combined with supportive is more effective than simple psychological intervention in depressive disorder.Venlafaxine has equivalent curative effect to fluoxetine in the treatment of depressive disorder,takes effect faster,and has higher safety and better compliance.