脑卒中后抑郁患者的临床观察

目的：分析脑卒中后抑郁患者的临床特点、发生机制及治疗转归。方法：从南京脑卒中注册系统的2019例脑血管病患者中，提取符合条件的首次急性脑梗死患者111例，于发病2周后用汉密顿抑郁量表（HAMD）、日常生活能力量表、简易智力状态检查进行评估，并行头颅MRI扫描，急性脑梗死后抑郁的患者随机给予西酞普兰或氟西汀治疗，3个月后随访。结果：在随访期内，有44例患者被诊断为脑卒中后抑郁（PSD），发生率为39．6％；左侧大脑半球梗死、额顶颞叶、基底核区及丘脑梗死与PSD发生具有相关性比数比（OR）〉1]，但差异无统计学意义；PSD组日常生活能力（ADL）及简明智能量表（MMSE）评分与对照组比较差异有显著性意义（P〈0．05）；经抗抑郁治疗3个月后，西酞普兰组和氟西汀组患者的HAMD和ADL评分治疗均有改善，但两组间比较差异无显著性意义：结论：PSD发病率较高，与大脑半球的梗死、范围及脑部基础病变有相关性。PSD可影响ADL和认知功能；西酞普兰和氟西汀均为有效的抗抑郁药物，两者疗效相当.

Preliminary result of poststroke depression: clinical characterics and therapy

Objective:To analyze clinical features,mechanisms and outcomes of poststroke depression.Methods:First-ever acute cerebral infarction patients(n=111) who were extracted from Nanjing stroke registration were evaluated with the Hamilton Rating scale for Depression(HAMD) 2 weeks after the onset,as well as the Activity of Daily Living Scale,and Mini-Mental State Examination were also included.Poststroke depression(PSD) patients were randomly treated with citalopram or fluoxetine,and the above-mentionde scales were re-tested 3 months after treatment.Results:There are 44 patients diagnosed with PSD(39.6%)in 111 envolled patients.Patients with left hemisphere infarction developed depression significantly more predominant than patients with right hemisphere infarction.PSD associated with lesions of the frontal cortex,temporal cortex,basal ganglia and cerebral ganglion(OR>1),but these differences were not significant between the groups.ADL score and MMSE score were significantly different between depression group and no-depression group(P<0.05).After 3 months with antidepresson treatment with citalopram or fluoxetine,HAMD and ADL improved significant two treatment groups(P<0.01),but there was no difference two groups(P>0.05).Conclusion:Incidence of PSD was high.Development of PSD related to the lateracy of infarction.PSD can influence activity of daily life and cognition.Citalopram and fluoxetine have equivalently good effects in treating PSD.