脑卒中后的早期抗抑郁治疗

目的：评估脑卒中后的早期抗抑郁治疗。方法选取发病8 d以内的序贯住院脑卒中患者120例，分为帕罗西汀干预组和对照组（各60例），干预组在发病第8天常规脑血管病治疗的基础上给予帕罗西汀20 mg 口服，每日一次，对照组仅给予常规脑血管病治疗。于发病第8天、第38天分别采用汉密尔顿抑郁量表（HAMD）和美国国立卫生研究院脑卒中量表（NIHSS）评定抑郁程度和神经功能缺损程度。结果两组发病第8天抑郁发生率分别为60.00％、61.67％，差异无统计学意义（χ2=0.03，P＞0.05）。两组发病第38天抑郁发生率分别为18.33％、38.33％，差异有统计学意义（χ2=5.91，P＜0.05）；干预组、对照组发病第8天和第38天抑郁发生率比较，差异均有统计学意义（χ2分别=21.86、6.53，P均＜0.05）。发病第8天，两组的HAMD评分和NIHSS评分比较，差异均无统计学意义（t分别=0.53、0.55，P均＞0.05）。发病第38天，干预组HAMD评分和NIHSS评分较对照组明显降低，差异均有统计学意义（t分别=2.37、4.15，P均＜0.05）；两组的HAMD评分和NIHSS评分均明显低于发病第8天，差异均有统计学意义（t分别=10.21、8.27；5.21、5.29，P均＜0.05）；且干预组HAMD评分和NIHSS评分下降的程度明显大于对照组（t分别=12.56、12.46，P均＜0.05）。结论脑卒中后的早期抗抑郁治疗更有利于减少抑郁的发生、促进神经功能的恢复。

Early antidepressant treatment after stroke

Objective To early assess antidepressant treatment after stroke. Methods Sequential 120 cases of hospitalized patients with stroke on the 8th onset-day were divided into paroxetine treatment group and the control group with 60 cases each. At the onset of 8th and 38th day, the hamilton depression scale （HAMD） and national institutes of health stroke scale（NIHSS）were taken to assess the degree of depression and nerve function defect degree. At the onset of 8th day, on the basis of conventional treatment of cerebrovascular disease, the intervention group was given paroxetine 20 mg orally once daily, the control group was only received conventional treatment of cerebrovascular disease. Results The incidence of depression state of two groups at the onset of 8th day were 60.00% and 61.67% respectively which had no significant difference（χ2=0.03,P〉0.05）. At the onset of 38th day, the incidence of depression of two groups were 18.33%and 38.33% respectively which has significant difference （χ2=5.91,P〈0.05）. The incidence of depression state of two groups at the onset of 8th versus 38th day respectively has significant differences （χ2=21.86,6.53,P〈0.05）. The HAMD score and NIHSS score between two groups at the onset of 8th day had no significant difference （t=0.53,0.55,P〉0.05）. At the onset of 38th day, the HAMD score and NIHSS score between two groups were significantly different （t=2.37,4.15, P〈0.05）, and the HAMD score and NIHSS score of two groups were significantly different compared with the onset of 8th day（t=10.21,8.27;5.21,5.29, P〈0.05）. The decreased extent of HAMD score and NIHSS score in the intervention group were significantly larger than those in the control group （t=12.56,12.46,P〈0.05）. Conclusion Early antidepressant treatment after stroke is benefit for reducing the occurrence of depression and promoting the recovery of neurological function.