西酞普兰治疗急性卒中后抑郁的疗效及其对卒中康复的影响

目的观察西酞普兰治疗急性卒中后抑郁的疗效及其对卒中康复的影响。方法105例急性卒中后抑郁患者随机分为西酞普兰组(52例)和对照组(53例),2组均接受常规药物治疗,治疗组同时加用西酞普兰治疗。治疗前后应用Hamilton抑郁量表(HRSD)评价抑郁状况,治疗前、治疗后4周和12周采用简易智能状态量表(MMSE)、中国卒中量表(CSS)和Barthel指数(BI)评价患者的认知和神经功能状况。结果治疗组1例死亡,1例失访;对照组2例死亡,2例失访。治疗后12周时西酞普兰组治愈率和总有效率分别为64%和96%,显著高于对照组的16·33%和57·44%(P<0·05)。治疗后4周和12周时西酞普兰组MMSE评分较对照组显著增加(P<0·01)。治疗后4周时,两组CSS和BI评分均有改善,但无显著性差异;治疗12周后西酞普兰组CSS和BI评分均优于对照组(P<0·01)。西酞普兰的主要不良反应为中枢神经系统和消化系统反应,但症状轻微。结论西酞普兰治疗卒中后抑郁安全有效,且能改善12周时的认知功能、神经功能和转归。

The Efficacy of Citalopram for Poststroke Depression and Its Effect on Stroke Rehabilitation

Objectives: To observe the efficacy of citalopram in the treatment of poststroke depression (PSD) and its effect on stroke rehabilitation. Methods: A total of the 105 patients with PSD were randomly allocated into citalopram-treated group (n=52) and control group (n=53). Both groups were treated with conventional drugs, and citalopram was added to the treated group. The depression status of the patients was evaluated by using Hamilton Rating Scale for Depression (HRSD) before and after the treatment, their cognitive and neurological status was evaluated by using Mini-Mental State Examination (MMSE), Chinese Stroke Scale (CSS) and Barthel Index (BI) 4 and 12 weeks before and after the treatment. Results: One patient died and another was lost to follow-up in the citalopram-treated group. Two patients died and two were lost to follow-up in the control group. Twelve weeks after the treatment, the cure rate and overall effective rate in the citalopram-treated group were 64% and 96%, respectively; they were significantly higher than the control group (16.33% and 57.44%; P<0.05). The MMSE score increased more significantly in the citalopram-treated group than that in the control group 4 and 12 weeks after the treatment (P<0.01). Both CSS and BI improved in the 2 groups 4 weeks after the treatment, but there was no significant difference. CSS and BI scores in the citalopram-treated group were better than those in the control group 12 weeks after the treatment (P<0.01). The major side effects of citalopram were digestive and central nervous system symptomes; however, these were mild and transient. Conclusions: Citalopram is safe and effective in the treatment of PSD, and it may improve cognitive function, neurological function, and outcome at 12 weeks.